{"hospital_name":"Arizona General Hospital - Laveen Hospital","last_updated_on":"2026-02-28","version":"3.0.0","location_name": ["Arizona General Hospital - Laveen Hospital"],"hospital_address": ["7171 S 51st Ave, Phoenix, AZ 85339"],"license_information":{"license_number":"H6937","state":"AZ"},"type_2_npi": ["1154748416"],"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":"Douglas  Ross MD,  Hospital President"},"standard_charge_information":[{"description":"FNA BX W/O IMG GDN EA ADDL","code_information":[{"code":"10004","type":"CPT"}],"standard_charges":[{"minimum":45.06,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/US GDN 1ST LES","code_information":[{"code":"10005","type":"CPT"}],"standard_charges":[{"minimum":75.81,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/US GDN EA ADDL","code_information":[{"code":"10006","type":"CPT"}],"standard_charges":[{"minimum":52.21,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/FLUOR GDN 1ST LES","code_information":[{"code":"10007","type":"CPT"}],"standard_charges":[{"minimum":92.98,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/FLUOR GDN EA ADDL","code_information":[{"code":"10008","type":"CPT"}],"standard_charges":[{"minimum":53.28,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/CT GDN 1ST LES","code_information":[{"code":"10009","type":"CPT"}],"standard_charges":[{"minimum":112.65,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/CT GDN EA ADDL","code_information":[{"code":"10010","type":"CPT"}],"standard_charges":[{"minimum":74.74,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.74,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/MR GDN 1ST LES","code_information":[{"code":"10011","type":"CPT"}],"standard_charges":[{"minimum":102.93,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1311.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":983.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":983.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/MR GDN EA ADDL","code_information":[{"code":"10012","type":"CPT"}],"standard_charges":[{"minimum":67.1,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":655.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":491.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":491.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.1,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/O IMG GDN 1ST LES","code_information":[{"code":"10021","type":"CPT"}],"standard_charges":[{"minimum":57.22,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"GUIDE CATHET FLUID DRAINAGE","code_information":[{"code":"10030","type":"CPT"}],"standard_charges":[{"minimum":139.47,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV SOFT TISS 1ST IMAG","code_information":[{"code":"10035","type":"CPT"}],"standard_charges":[{"minimum":86.9,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV SOFT TISS ADD IMAG","code_information":[{"code":"10036","type":"CPT"}],"standard_charges":[{"minimum":43.99,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"}]}]},{"description":"ACNE SURGERY","code_information":[{"code":"10040","type":"CPT"}],"standard_charges":[{"minimum":162.24,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SKIN ABSCESS","code_information":[{"code":"10060","type":"CPT"}],"standard_charges":[{"minimum":112.65,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SKIN ABSCESS","code_information":[{"code":"10061","type":"CPT"}],"standard_charges":[{"minimum":194.54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PILONIDAL CYST","code_information":[{"code":"10080","type":"CPT"}],"standard_charges":[{"minimum":111.22,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PILONIDAL CYST","code_information":[{"code":"10081","type":"CPT"}],"standard_charges":[{"minimum":179.88,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY","code_information":[{"code":"10120","type":"CPT"}],"standard_charges":[{"minimum":111.58,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY","code_information":[{"code":"10121","type":"CPT"}],"standard_charges":[{"minimum":193.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"10140","type":"CPT"}],"standard_charges":[{"minimum":124.81,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"PUNCTURE DRAINAGE OF LESION","code_information":[{"code":"10160","type":"CPT"}],"standard_charges":[{"minimum":101.92,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"COMPLEX DRAINAGE WOUND","code_information":[{"code":"10180","type":"CPT"}],"standard_charges":[{"minimum":187.75,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE INFECTED SKIN","code_information":[{"code":"11000","type":"CPT"}],"standard_charges":[{"minimum":28.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE INFECTED SKIN ADD-ON","code_information":[{"code":"11001","type":"CPT"}],"standard_charges":[{"minimum":15.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE GENITALIA  PERINEUM","code_information":[{"code":"11004","type":"CPT"}],"standard_charges":[{"minimum":587.92,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.92,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE ABDOM WALL","code_information":[{"code":"11005","type":"CPT"}],"standard_charges":[{"minimum":798.2,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE GENIT/PER/ABDOM WALL","code_information":[{"code":"11006","type":"CPT"}],"standard_charges":[{"minimum":723.46,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.46,"methodology":"fee schedule"}]}]},{"description":"REMOVE MESH FROM ABD WALL","code_information":[{"code":"11008","type":"CPT"}],"standard_charges":[{"minimum":280.73,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.73,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE SKIN AT FX SITE","code_information":[{"code":"11010","type":"CPT"}],"standard_charges":[{"minimum":288.6,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE SKIN MUSC AT FX SITE","code_information":[{"code":"11011","type":"CPT"}],"standard_charges":[{"minimum":309.7,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"DEB SKIN BONE AT FX SITE","code_information":[{"code":"11012","type":"CPT"}],"standard_charges":[{"minimum":432.72,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DEB SUBQ TISSUE 20 SQ CM/<","code_information":[{"code":"11042","type":"CPT"}],"standard_charges":[{"minimum":63.3,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":712.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":534.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":534.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DEB MUSC/FASCIA 20 SQ CM/<","code_information":[{"code":"11043","type":"CPT"}],"standard_charges":[{"minimum":160.21,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"DEB BONE 20 SQ CM/<","code_information":[{"code":"11044","type":"CPT"}],"standard_charges":[{"minimum":234.95,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DEB SUBQ TISSUE ADD-ON","code_information":[{"code":"11045","type":"CPT"}],"standard_charges":[{"minimum":26.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":266.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":266.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"}]}]},{"description":"DEB MUSC/FASCIA ADD-ON","code_information":[{"code":"11046","type":"CPT"}],"standard_charges":[{"minimum":56.86,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"}]}]},{"description":"DEB BONE ADD-ON","code_information":[{"code":"11047","type":"CPT"}],"standard_charges":[{"minimum":100.49,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"}]}]},{"description":"TRIM SKIN LESION","code_information":[{"code":"11055","type":"CPT"}],"standard_charges":[{"minimum":16.09,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"TRIM SKIN LESIONS 2 TO 4","code_information":[{"code":"11056","type":"CPT"}],"standard_charges":[{"minimum":22.89,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"TRIM SKIN LESIONS OVER 4","code_information":[{"code":"11057","type":"CPT"}],"standard_charges":[{"minimum":30.04,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"TANGNTL BX SKIN SINGLE LES","code_information":[{"code":"11102","type":"CPT"}],"standard_charges":[{"minimum":39.34,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":133.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":133.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"TANGNTL BX SKIN EA SEP/ADDL","code_information":[{"code":"11103","type":"CPT"}],"standard_charges":[{"minimum":22.89,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"}]}]},{"description":"PUNCH BX SKIN SINGLE LESION","code_information":[{"code":"11104","type":"CPT"}],"standard_charges":[{"minimum":48.64,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":167.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":167.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"PUNCH BX SKIN EA SEP/ADDL","code_information":[{"code":"11105","type":"CPT"}],"standard_charges":[{"minimum":26.46,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"}]}]},{"description":"INCAL BX SKN SINGLE LES","code_information":[{"code":"11106","type":"CPT"}],"standard_charges":[{"minimum":59.01,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"INCAL BX SKN EA SEP/ADDL","code_information":[{"code":"11107","type":"CPT"}],"standard_charges":[{"minimum":31.83,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":109.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":109.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SKIN TAGS <W/15","code_information":[{"code":"11200","type":"CPT"}],"standard_charges":[{"minimum":80.82,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"REMOVE SKIN TAGS ADD-ON","code_information":[{"code":"11201","type":"CPT"}],"standard_charges":[{"minimum":16.81,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.81,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11300","type":"CPT"}],"standard_charges":[{"minimum":35.4,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 0.6-1.0 CM","code_information":[{"code":"11301","type":"CPT"}],"standard_charges":[{"minimum":53.28,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 1.1-2.0 CM","code_information":[{"code":"11302","type":"CPT"}],"standard_charges":[{"minimum":62.23,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11303","type":"CPT"}],"standard_charges":[{"minimum":74.03,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11305","type":"CPT"}],"standard_charges":[{"minimum":38.98,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 0.6-1.0 CM","code_information":[{"code":"11306","type":"CPT"}],"standard_charges":[{"minimum":51.14,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 1.1-2.0 CM","code_information":[{"code":"11307","type":"CPT"}],"standard_charges":[{"minimum":65.09,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11308","type":"CPT"}],"standard_charges":[{"minimum":72.95,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11310","type":"CPT"}],"standard_charges":[{"minimum":47.56,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 0.6-1.0 CM","code_information":[{"code":"11311","type":"CPT"}],"standard_charges":[{"minimum":65.44,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION 1.1-2.0 CM","code_information":[{"code":"11312","type":"CPT"}],"standard_charges":[{"minimum":77.25,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11313","type":"CPT"}],"standard_charges":[{"minimum":100.13,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT B9+MARG 0.5 CM<","code_information":[{"code":"11400","type":"CPT"}],"standard_charges":[{"minimum":89.05,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT B9+MARG 0.6-1 CM","code_information":[{"code":"11401","type":"CPT"}],"standard_charges":[{"minimum":111.58,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT B9+MARG 1.1-2 CM","code_information":[{"code":"11402","type":"CPT"}],"standard_charges":[{"minimum":122.31,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT B9+MARG 2.1-3CM","code_information":[{"code":"11403","type":"CPT"}],"standard_charges":[{"minimum":158.07,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT B9+MARG 3.1-4 CM","code_information":[{"code":"11404","type":"CPT"}],"standard_charges":[{"minimum":173.8,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT B9+MARG >4.0 CM","code_information":[{"code":"11406","type":"CPT"}],"standard_charges":[{"minimum":261.42,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC H-F-NK-SP B9+MARG 0.5/<","code_information":[{"code":"11420","type":"CPT"}],"standard_charges":[{"minimum":86.9,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC H-F-NK-SP B9+MARG 0.6-1","code_information":[{"code":"11421","type":"CPT"}],"standard_charges":[{"minimum":115.15,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC H-F-NK-SP B9+MARG 1.1-2","code_information":[{"code":"11422","type":"CPT"}],"standard_charges":[{"minimum":143.4,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC H-F-NK-SP B9+MARG 2.1-3","code_information":[{"code":"11423","type":"CPT"}],"standard_charges":[{"minimum":165.93,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC H-F-NK-SP B9+MARG 3.1-4","code_information":[{"code":"11424","type":"CPT"}],"standard_charges":[{"minimum":190.97,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC H-F-NK-SP B9+MARG >4 CM","code_information":[{"code":"11426","type":"CPT"}],"standard_charges":[{"minimum":281.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC FACE-MM B9+MARG 0.5 CM/<","code_information":[{"code":"11440","type":"CPT"}],"standard_charges":[{"minimum":113.36,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC FACE-MM B9+MARG 0.6-1 CM","code_information":[{"code":"11441","type":"CPT"}],"standard_charges":[{"minimum":140.9,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC FACE-MM B9+MARG 1.1-2 CM","code_information":[{"code":"11442","type":"CPT"}],"standard_charges":[{"minimum":155.21,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC FACE-MM B9+MARG 2.1-3 CM","code_information":[{"code":"11443","type":"CPT"}],"standard_charges":[{"minimum":188.82,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC FACE-MM B9+MARG 3.1-4 CM","code_information":[{"code":"11444","type":"CPT"}],"standard_charges":[{"minimum":237.82,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC FACE-MM B9+MARG >4 CM","code_information":[{"code":"11446","type":"CPT"}],"standard_charges":[{"minimum":333.66,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11450","type":"CPT"}],"standard_charges":[{"minimum":276.44,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11451","type":"CPT"}],"standard_charges":[{"minimum":349.39,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11462","type":"CPT"}],"standard_charges":[{"minimum":263.21,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11463","type":"CPT"}],"standard_charges":[{"minimum":351.18,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11470","type":"CPT"}],"standard_charges":[{"minimum":302.54,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11471","type":"CPT"}],"standard_charges":[{"minimum":370.85,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT MAL+MARG 0.5 CM/<","code_information":[{"code":"11600","type":"CPT"}],"standard_charges":[{"minimum":128.74,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT MAL+MARG 0.6-1 CM","code_information":[{"code":"11601","type":"CPT"}],"standard_charges":[{"minimum":155.92,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT MAL+MARG 1.1-2 CM","code_information":[{"code":"11602","type":"CPT"}],"standard_charges":[{"minimum":169.51,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT MAL+MARG 2.1-3 CM","code_information":[{"code":"11603","type":"CPT"}],"standard_charges":[{"minimum":202.41,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT MAL+MARG 3.1-4 CM","code_information":[{"code":"11604","type":"CPT"}],"standard_charges":[{"minimum":222.44,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC TR-EXT MAL+MARG >4 CM","code_information":[{"code":"11606","type":"CPT"}],"standard_charges":[{"minimum":330.44,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC H-F-NK-SP MAL+MARG 0.5/<","code_information":[{"code":"11620","type":"CPT"}],"standard_charges":[{"minimum":129.81,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG 0.6-1","code_information":[{"code":"11621","type":"CPT"}],"standard_charges":[{"minimum":156.64,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG 1.1-2","code_information":[{"code":"11622","type":"CPT"}],"standard_charges":[{"minimum":177.74,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG 2.1-3","code_information":[{"code":"11623","type":"CPT"}],"standard_charges":[{"minimum":218.86,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG 3.1-4","code_information":[{"code":"11624","type":"CPT"}],"standard_charges":[{"minimum":248.9,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC S/N/H/F/G MAL+MRG >4 CM","code_information":[{"code":"11626","type":"CPT"}],"standard_charges":[{"minimum":303.62,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 0.5CM<","code_information":[{"code":"11640","type":"CPT"}],"standard_charges":[{"minimum":133.39,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 0.6-1","code_information":[{"code":"11641","type":"CPT"}],"standard_charges":[{"minimum":163.43,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 1.1-2","code_information":[{"code":"11642","type":"CPT"}],"standard_charges":[{"minimum":190.97,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 2.1-3","code_information":[{"code":"11643","type":"CPT"}],"standard_charges":[{"minimum":237.82,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG 3.1-4","code_information":[{"code":"11644","type":"CPT"}],"standard_charges":[{"minimum":294.32,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC F/E/E/N/L MAL+MRG >4 CM","code_information":[{"code":"11646","type":"CPT"}],"standard_charges":[{"minimum":406.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"TRIM NAIL(S) ANY NUMBER","code_information":[{"code":"11719","type":"CPT"}],"standard_charges":[{"minimum":7.87,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE NAIL 1-5","code_information":[{"code":"11720","type":"CPT"}],"standard_charges":[{"minimum":14.66,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE NAIL 6 OR MORE","code_information":[{"code":"11721","type":"CPT"}],"standard_charges":[{"minimum":24.68,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NAIL PLATE","code_information":[{"code":"11730","type":"CPT"}],"standard_charges":[{"minimum":56.5,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"REMOVE NAIL PLATE ADD-ON","code_information":[{"code":"11732","type":"CPT"}],"standard_charges":[{"minimum":17.52,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"}]}]},{"description":"DRAIN BLOOD FROM UNDER NAIL","code_information":[{"code":"11740","type":"CPT"}],"standard_charges":[{"minimum":33.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NAIL BED","code_information":[{"code":"11750","type":"CPT"}],"standard_charges":[{"minimum":107.64,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"BIOPSY NAIL UNIT","code_information":[{"code":"11755","type":"CPT"}],"standard_charges":[{"minimum":63.3,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF NAIL BED","code_information":[{"code":"11760","type":"CPT"}],"standard_charges":[{"minimum":115.51,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF NAIL BED","code_information":[{"code":"11762","type":"CPT"}],"standard_charges":[{"minimum":196.69,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF NAIL FOLD TOE","code_information":[{"code":"11765","type":"CPT"}],"standard_charges":[{"minimum":98.34,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"REMOVE PILONIDAL CYST SIMPLE","code_information":[{"code":"11770","type":"CPT"}],"standard_charges":[{"minimum":194.9,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE PILONIDAL CYST EXTEN","code_information":[{"code":"11771","type":"CPT"}],"standard_charges":[{"minimum":474.2,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE PILONIDAL CYST COMPL","code_information":[{"code":"11772","type":"CPT"}],"standard_charges":[{"minimum":610.09,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"INJECT SKIN LESIONS </W 7","code_information":[{"code":"11900","type":"CPT"}],"standard_charges":[{"minimum":31.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"INJECT SKIN LESIONS >7","code_information":[{"code":"11901","type":"CPT"}],"standard_charges":[{"minimum":47.56,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"CORRECT SKIN COLOR 6.0 CM/<","code_information":[{"code":"11920","type":"CPT"}],"standard_charges":[{"minimum":119.09,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CORRECT SKN COLOR 6.1-20.0CM","code_information":[{"code":"11921","type":"CPT"}],"standard_charges":[{"minimum":136.61,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"TX CONTOUR DEFECTS 1 CC/<","code_information":[{"code":"11950","type":"CPT"}],"standard_charges":[{"minimum":211.78,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"TX CONTOUR DEFECTS 1.1-5.0CC","code_information":[{"code":"11951","type":"CPT"}],"standard_charges":[{"minimum":257.15,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"TX CONTOUR DEFECTS 5.1-10CC","code_information":[{"code":"11952","type":"CPT"}],"standard_charges":[{"minimum":257.15,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"TX CONTOUR DEFECTS >10.0 CC","code_information":[{"code":"11954","type":"CPT"}],"standard_charges":[{"minimum":257.15,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"INSERT TISSUE EXPANDER(S)","code_information":[{"code":"11960","type":"CPT"}],"standard_charges":[{"minimum":1068.2,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REPLACE TISSUE EXPANDER","code_information":[{"code":"11970","type":"CPT"}],"standard_charges":[{"minimum":591.86,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE TISSUE EXPANDER(S)","code_information":[{"code":"11971","type":"CPT"}],"standard_charges":[{"minimum":582.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE CONTRACEPTIVE CAPSULE","code_information":[{"code":"11976","type":"CPT"}],"standard_charges":[{"minimum":96.91,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1169.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":877.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":877.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"IMPLANT HORMONE PELLET(S)","code_information":[{"code":"11980","type":"CPT"}],"standard_charges":[{"minimum":57.93,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"INSERT DRUG IMPLANT DEVICE","code_information":[{"code":"11981","type":"CPT"}],"standard_charges":[{"minimum":65.44,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE DRUG IMPLANT DEVICE","code_information":[{"code":"11982","type":"CPT"}],"standard_charges":[{"minimum":76.17,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE/INSERT DRUG IMPLANT","code_information":[{"code":"11983","type":"CPT"}],"standard_charges":[{"minimum":107.64,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"RPR S/N/AX/GEN/TRNK 2.5CM/<","code_information":[{"code":"12001","type":"CPT"}],"standard_charges":[{"minimum":46.85,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"RPR S/N/AX/GEN/TRNK2.6-7.5CM","code_information":[{"code":"12002","type":"CPT"}],"standard_charges":[{"minimum":61.51,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"RPR S/N/AX/GEN/TRK7.6-12.5CM","code_information":[{"code":"12004","type":"CPT"}],"standard_charges":[{"minimum":76.89,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"RPR S/N/A/GEN/TRK12.6-20.0CM","code_information":[{"code":"12005","type":"CPT"}],"standard_charges":[{"minimum":98.7,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"RPR S/N/A/GEN/TRK20.1-30.0CM","code_information":[{"code":"12006","type":"CPT"}],"standard_charges":[{"minimum":120.87,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"RPR S/N/AX/GEN/TRNK >30.0 CM","code_information":[{"code":"12007","type":"CPT"}],"standard_charges":[{"minimum":149.84,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"RPR F/E/E/N/L/M 2.5 CM/<","code_information":[{"code":"12011","type":"CPT"}],"standard_charges":[{"minimum":57.93,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"RPR F/E/E/N/L/M 2.6-5.0 CM","code_information":[{"code":"12013","type":"CPT"}],"standard_charges":[{"minimum":60.44,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"RPR F/E/E/N/L/M 5.1-7.5 CM","code_information":[{"code":"12014","type":"CPT"}],"standard_charges":[{"minimum":77.96,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"RPR F/E/E/N/L/M 7.6-12.5 CM","code_information":[{"code":"12015","type":"CPT"}],"standard_charges":[{"minimum":97.99,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"RPR FE/E/EN/L/M 12.6-20.0 CM","code_information":[{"code":"12016","type":"CPT"}],"standard_charges":[{"minimum":133.03,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"RPR FE/E/EN/L/M 20.1-30.0 CM","code_information":[{"code":"12017","type":"CPT"}],"standard_charges":[{"minimum":160.21,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"RPR F/E/E/N/L/M >30.0 CM","code_information":[{"code":"12018","type":"CPT"}],"standard_charges":[{"minimum":180.6,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF SPLIT WOUND","code_information":[{"code":"12020","type":"CPT"}],"standard_charges":[{"minimum":197.76,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF SPLIT WOUND","code_information":[{"code":"12021","type":"CPT"}],"standard_charges":[{"minimum":148.41,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR S/A/T/EXT 2.5 CM/<","code_information":[{"code":"12031","type":"CPT"}],"standard_charges":[{"minimum":159.14,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR S/A/T/EXT 2.6-7.5","code_information":[{"code":"12032","type":"CPT"}],"standard_charges":[{"minimum":199.91,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR S/TR/EXT 7.6-12.5","code_information":[{"code":"12034","type":"CPT"}],"standard_charges":[{"minimum":215.29,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR S/A/T/EXT 12.6-20","code_information":[{"code":"12035","type":"CPT"}],"standard_charges":[{"minimum":252.84,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR S/A/T/EXT 20.1-30","code_information":[{"code":"12036","type":"CPT"}],"standard_charges":[{"minimum":295.39,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR S/TR/EXT >30.0 CM","code_information":[{"code":"12037","type":"CPT"}],"standard_charges":[{"minimum":342.95,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR N-HF/GENIT 2.5CM/<","code_information":[{"code":"12041","type":"CPT"}],"standard_charges":[{"minimum":152.34,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR N-HF/GENIT2.6-7.5","code_information":[{"code":"12042","type":"CPT"}],"standard_charges":[{"minimum":205.27,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR N-HF/GENIT7.6-12.5","code_information":[{"code":"12044","type":"CPT"}],"standard_charges":[{"minimum":224.58,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR N-HF/GENIT12.6-20","code_information":[{"code":"12045","type":"CPT"}],"standard_charges":[{"minimum":286.81,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR N-HF/GENIT20.1-30","code_information":[{"code":"12046","type":"CPT"}],"standard_charges":[{"minimum":332.94,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR N-HF/GENIT >30.0CM","code_information":[{"code":"12047","type":"CPT"}],"standard_charges":[{"minimum":369.06,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR FACE/MM 2.5 CM/<","code_information":[{"code":"12051","type":"CPT"}],"standard_charges":[{"minimum":177.74,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR FACE/MM 2.6-5.0 CM","code_information":[{"code":"12052","type":"CPT"}],"standard_charges":[{"minimum":209.21,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR FACE/MM 5.1-7.5 CM","code_information":[{"code":"12053","type":"CPT"}],"standard_charges":[{"minimum":225.66,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR FACE/MM 7.6-12.5CM","code_information":[{"code":"12054","type":"CPT"}],"standard_charges":[{"minimum":230.66,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR FACE/MM 12.6-20 CM","code_information":[{"code":"12055","type":"CPT"}],"standard_charges":[{"minimum":316.13,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR FACE/MM 20.1-30.0","code_information":[{"code":"12056","type":"CPT"}],"standard_charges":[{"minimum":402.32,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INTMD RPR FACE/MM >30.0 CM","code_information":[{"code":"12057","type":"CPT"}],"standard_charges":[{"minimum":425.83,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR TRUNK 1.1-2.5 CM","code_information":[{"code":"13100","type":"CPT"}],"standard_charges":[{"minimum":209.56,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR TRUNK 2.6-7.5 CM","code_information":[{"code":"13101","type":"CPT"}],"standard_charges":[{"minimum":257.84,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR TRUNK ADDL 5CM/<","code_information":[{"code":"13102","type":"CPT"}],"standard_charges":[{"minimum":74.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR S/A/L 1.1-2.5 CM","code_information":[{"code":"13120","type":"CPT"}],"standard_charges":[{"minimum":242.11,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR S/A/L 2.6-7.5 CM","code_information":[{"code":"13121","type":"CPT"}],"standard_charges":[{"minimum":269.29,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR S/A/L ADDL 5 CM/>","code_information":[{"code":"13122","type":"CPT"}],"standard_charges":[{"minimum":85.83,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR F/C/C/M/N/AX/G/H/F","code_information":[{"code":"13131","type":"CPT"}],"standard_charges":[{"minimum":252.84,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR F/C/C/M/N/AX/G/H/F","code_information":[{"code":"13132","type":"CPT"}],"standard_charges":[{"minimum":315.78,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR F/C/C/M/N/AX/G/H/F","code_information":[{"code":"13133","type":"CPT"}],"standard_charges":[{"minimum":130.53,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR E/N/E/L 1.1-2.5 CM","code_information":[{"code":"13151","type":"CPT"}],"standard_charges":[{"minimum":290.39,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR E/N/E/L 2.6-7.5 CM","code_information":[{"code":"13152","type":"CPT"}],"standard_charges":[{"minimum":349.75,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR E/N/E/L ADDL 5CM/<","code_information":[{"code":"13153","type":"CPT"}],"standard_charges":[{"minimum":141.62,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"}]}]},{"description":"LATE CLOSURE OF WOUND","code_information":[{"code":"13160","type":"CPT"}],"standard_charges":[{"minimum":834.68,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR TRUNK 10 SQ CM/<","code_information":[{"code":"14000","type":"CPT"}],"standard_charges":[{"minimum":530.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR TRUNK 10.1-30SQCM","code_information":[{"code":"14001","type":"CPT"}],"standard_charges":[{"minimum":686.27,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR S/A/L 10 SQ CM/<","code_information":[{"code":"14020","type":"CPT"}],"standard_charges":[{"minimum":596.86,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR S/A/L 10.1-30 SQCM","code_information":[{"code":"14021","type":"CPT"}],"standard_charges":[{"minimum":744.56,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR F/C/C/M/N/A/G/H/F","code_information":[{"code":"14040","type":"CPT"}],"standard_charges":[{"minimum":655.87,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR F/C/C/M/N/A/G/H/F","code_information":[{"code":"14041","type":"CPT"}],"standard_charges":[{"minimum":800.35,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR E/N/E/L 10 SQ CM/<","code_information":[{"code":"14060","type":"CPT"}],"standard_charges":[{"minimum":698.78,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR E/N/E/L10.1-30SQCM","code_information":[{"code":"14061","type":"CPT"}],"standard_charges":[{"minimum":859.35,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":859.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":859.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":859.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR ANY 30.1-60 SQ CM","code_information":[{"code":"14301","type":"CPT"}],"standard_charges":[{"minimum":910.85,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":910.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":910.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":910.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"TIS TRNFR ADDL 30 SQ CM","code_information":[{"code":"14302","type":"CPT"}],"standard_charges":[{"minimum":223.51,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.51,"methodology":"fee schedule"}]}]},{"description":"FILLETED FINGER/TOE FLAP","code_information":[{"code":"14350","type":"CPT"}],"standard_charges":[{"minimum":712.37,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"WOUND PREP TRK/ARM/LEG","code_information":[{"code":"15002","type":"CPT"}],"standard_charges":[{"minimum":228.16,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"WOUND PREP ADDL 100 CM","code_information":[{"code":"15003","type":"CPT"}],"standard_charges":[{"minimum":46.49,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"}]}]},{"description":"WOUND PREP F/N/HF/G","code_information":[{"code":"15004","type":"CPT"}],"standard_charges":[{"minimum":270.36,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"WND PREP F/N/HF/G ADDL CM","code_information":[{"code":"15005","type":"CPT"}],"standard_charges":[{"minimum":92.62,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"}]}]},{"description":"HARVEST CULTURED SKIN GRAFT","code_information":[{"code":"15040","type":"CPT"}],"standard_charges":[{"minimum":130.53,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN PINCH GRAFT","code_information":[{"code":"15050","type":"CPT"}],"standard_charges":[{"minimum":480.99,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"SKIN SPLT GRFT TRNK/ARM/LEG","code_information":[{"code":"15100","type":"CPT"}],"standard_charges":[{"minimum":750.64,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN SPLT GRFT T/A/L ADD-ON","code_information":[{"code":"15101","type":"CPT"}],"standard_charges":[{"minimum":114.8,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"}]}]},{"description":"EPIDRM AUTOGRFT TRNK/ARM/LEG","code_information":[{"code":"15110","type":"CPT"}],"standard_charges":[{"minimum":749.57,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"EPIDRM AUTOGRFT T/A/L ADD-ON","code_information":[{"code":"15111","type":"CPT"}],"standard_charges":[{"minimum":105.14,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"}]}]},{"description":"EPIDRM A-GRFT FACE/NCK/HF/G","code_information":[{"code":"15115","type":"CPT"}],"standard_charges":[{"minimum":731.33,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"EPIDRM A-GRFT F/N/HF/G ADDL","code_information":[{"code":"15116","type":"CPT"}],"standard_charges":[{"minimum":143.05,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"}]}]},{"description":"SKN SPLT A-GRFT FAC/NCK/HF/G","code_information":[{"code":"15120","type":"CPT"}],"standard_charges":[{"minimum":724.53,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"SKN SPLT A-GRFT F/N/HF/G ADD","code_information":[{"code":"15121","type":"CPT"}],"standard_charges":[{"minimum":136.61,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"}]}]},{"description":"DERM AUTOGRAFT TRNK/ARM/LEG","code_information":[{"code":"15130","type":"CPT"}],"standard_charges":[{"minimum":627.26,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"DERM AUTOGRAFT T/A/L ADD-ON","code_information":[{"code":"15131","type":"CPT"}],"standard_charges":[{"minimum":92.62,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"}]}]},{"description":"DERM AUTOGRAFT FACE/NCK/HF/G","code_information":[{"code":"15135","type":"CPT"}],"standard_charges":[{"minimum":795.7,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"DERM AUTOGRAFT F/N/HF/G ADD","code_information":[{"code":"15136","type":"CPT"}],"standard_charges":[{"minimum":92.62,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"}]}]},{"description":"CULT SKIN GRFT T/ARM/LEG","code_information":[{"code":"15150","type":"CPT"}],"standard_charges":[{"minimum":669.1,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"CULT SKIN GRFT T/A/L ADDL","code_information":[{"code":"15151","type":"CPT"}],"standard_charges":[{"minimum":112.65,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"}]}]},{"description":"CULT SKIN GRAFT T/A/L +%","code_information":[{"code":"15152","type":"CPT"}],"standard_charges":[{"minimum":144.12,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.12,"methodology":"fee schedule"}]}]},{"description":"CULT SKIN GRAFT F/N/HF/G","code_information":[{"code":"15155","type":"CPT"}],"standard_charges":[{"minimum":763.15,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"CULT SKIN GRFT F/N/HFG ADD","code_information":[{"code":"15156","type":"CPT"}],"standard_charges":[{"minimum":155.21,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"}]}]},{"description":"CULT EPIDERM GRFT F/N/HFG +%","code_information":[{"code":"15157","type":"CPT"}],"standard_charges":[{"minimum":169.15,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"}]}]},{"description":"SKIN FULL GRAFT TRUNK","code_information":[{"code":"15200","type":"CPT"}],"standard_charges":[{"minimum":707.01,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN FULL GRAFT TRUNK ADD-ON","code_information":[{"code":"15201","type":"CPT"}],"standard_charges":[{"minimum":79.39,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"}]}]},{"description":"SKIN FULL GRAFT SCLP/ARM/LEG","code_information":[{"code":"15220","type":"CPT"}],"standard_charges":[{"minimum":641.56,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15221","type":"CPT"}],"standard_charges":[{"minimum":71.52,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"}]}]},{"description":"SKIN FULL GRFT FACE/GENIT/HF","code_information":[{"code":"15240","type":"CPT"}],"standard_charges":[{"minimum":837.18,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15241","type":"CPT"}],"standard_charges":[{"minimum":111.22,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.22,"methodology":"fee schedule"}]}]},{"description":"SKIN FULL GRAFT EEN  LIPS","code_information":[{"code":"15260","type":"CPT"}],"standard_charges":[{"minimum":888.32,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15261","type":"CPT"}],"standard_charges":[{"minimum":140.9,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"}]}]},{"description":"SKIN SUB GRAFT TRNK/ARM/LEG","code_information":[{"code":"15271","type":"CPT"}],"standard_charges":[{"minimum":87.62,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN SUB GRAFT T/A/L ADD-ON","code_information":[{"code":"15272","type":"CPT"}],"standard_charges":[{"minimum":17.52,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"}]}]},{"description":"SKIN SUB GRFT T/ARM/LG CHILD","code_information":[{"code":"15273","type":"CPT"}],"standard_charges":[{"minimum":202.77,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"SKN SUB GRFT T/A/L CHILD ADD","code_information":[{"code":"15274","type":"CPT"}],"standard_charges":[{"minimum":46.13,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.13,"methodology":"fee schedule"}]}]},{"description":"SKIN SUB GRAFT FACE/NK/HF/G","code_information":[{"code":"15275","type":"CPT"}],"standard_charges":[{"minimum":97.27,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN SUB GRAFT F/N/HF/G ADDL","code_information":[{"code":"15276","type":"CPT"}],"standard_charges":[{"minimum":26.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"}]}]},{"description":"SKN SUB GRFT F/N/HF/G CHILD","code_information":[{"code":"15277","type":"CPT"}],"standard_charges":[{"minimum":231.02,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKN SUB GRFT F/N/HF/G CH ADD","code_information":[{"code":"15278","type":"CPT"}],"standard_charges":[{"minimum":57.58,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.58,"methodology":"fee schedule"}]}]},{"description":"SKIN PEDICLE FLAP TRUNK","code_information":[{"code":"15570","type":"CPT"}],"standard_charges":[{"minimum":764.23,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN PEDICLE FLAP ARMS/LEGS","code_information":[{"code":"15572","type":"CPT"}],"standard_charges":[{"minimum":773.53,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":773.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":773.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":773.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"PEDCLE FH/CH/CH/M/N/AX/G/H/F","code_information":[{"code":"15574","type":"CPT"}],"standard_charges":[{"minimum":777.46,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"PEDICLE E/N/E/L/NTRORAL","code_information":[{"code":"15576","type":"CPT"}],"standard_charges":[{"minimum":680.55,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"DELAY FLAP TRUNK","code_information":[{"code":"15600","type":"CPT"}],"standard_charges":[{"minimum":224.23,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"DELAY FLAP ARMS/LEGS","code_information":[{"code":"15610","type":"CPT"}],"standard_charges":[{"minimum":258.2,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"DELAY FLAP F/C/C/N/AX/G/H/F","code_information":[{"code":"15620","type":"CPT"}],"standard_charges":[{"minimum":345.1,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"DELAY FLAP EYE/NOS/EAR/LIP","code_information":[{"code":"15630","type":"CPT"}],"standard_charges":[{"minimum":362.98,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"TRANSFER SKIN PEDICLE FLAP","code_information":[{"code":"15650","type":"CPT"}],"standard_charges":[{"minimum":425.92,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"MDFC FLAP W/PRSRV VASC PEDCL","code_information":[{"code":"15730","type":"CPT"}],"standard_charges":[{"minimum":960.2,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"FOREHEAD FLAP W/VASC PEDICLE","code_information":[{"code":"15731","type":"CPT"}],"standard_charges":[{"minimum":1046.74,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"MUSC MYOQ/FSCQ FLP HN PEDCL","code_information":[{"code":"15733","type":"CPT"}],"standard_charges":[{"minimum":1078.57,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"MUSCLE-SKIN GRAFT TRUNK","code_information":[{"code":"15734","type":"CPT"}],"standard_charges":[{"minimum":1568.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1568.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1568.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1568.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"MUSCLE-SKIN GRAFT ARM","code_information":[{"code":"15736","type":"CPT"}],"standard_charges":[{"minimum":1275.98,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"MUSCLE-SKIN GRAFT LEG","code_information":[{"code":"15738","type":"CPT"}],"standard_charges":[{"minimum":1325.69,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"ISLAND PEDICLE FLAP GRAFT","code_information":[{"code":"15740","type":"CPT"}],"standard_charges":[{"minimum":884.74,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"NEUROVASCULAR PEDICLE FLAP","code_information":[{"code":"15750","type":"CPT"}],"standard_charges":[{"minimum":980.23,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"FREE MYO/SKIN FLAP MICROVASC","code_information":[{"code":"15756","type":"CPT"}],"standard_charges":[{"minimum":2385.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2385.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2385.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2385.31,"methodology":"fee schedule"}]}]},{"description":"FREE SKIN FLAP MICROVASC","code_information":[{"code":"15757","type":"CPT"}],"standard_charges":[{"minimum":2370.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2370.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2370.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2370.64,"methodology":"fee schedule"}]}]},{"description":"FREE FASCIAL FLAP MICROVASC","code_information":[{"code":"15758","type":"CPT"}],"standard_charges":[{"minimum":2360.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2360.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2360.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2360.99,"methodology":"fee schedule"}]}]},{"description":"COMPOSITE SKIN GRAFT","code_information":[{"code":"15760","type":"CPT"}],"standard_charges":[{"minimum":734.19,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"GRFG AUTOL SOFT TISS DIR EXC","code_information":[{"code":"15769","type":"CPT"}],"standard_charges":[{"minimum":505.31,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"DERMA-FAT-FASCIA GRAFT","code_information":[{"code":"15770","type":"CPT"}],"standard_charges":[{"minimum":709.87,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"GRFG AUTOL FAT LIPO 50 CC/<","code_information":[{"code":"15771","type":"CPT"}],"standard_charges":[{"minimum":538.93,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"GRFG AUTOL FAT LIPO EA ADDL","code_information":[{"code":"15772","type":"CPT"}],"standard_charges":[{"minimum":154.13,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.13,"methodology":"fee schedule"}]}]},{"description":"GRFG AUTOL FAT LIPO 25 CC/<","code_information":[{"code":"15773","type":"CPT"}],"standard_charges":[{"minimum":527.84,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"GFRG AUTOL FAT LIPO EA ADDL","code_information":[{"code":"15774","type":"CPT"}],"standard_charges":[{"minimum":148.77,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"}]}]},{"description":"HAIR TRNSPL 1-15 PUNCH GRFTS","code_information":[{"code":"15775","type":"CPT"}],"standard_charges":[{"minimum":425.83,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"HAIR TRNSPL >15 PUNCH GRAFTS","code_information":[{"code":"15776","type":"CPT"}],"standard_charges":[{"minimum":425.83,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"ACELLULAR DERM MATRIX IMPLT","code_information":[{"code":"15777","type":"CPT"}],"standard_charges":[{"minimum":222.44,"maximum":3048.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"}]}]},{"description":"DERMABRASION TOTAL FACE","code_information":[{"code":"15780","type":"CPT"}],"standard_charges":[{"minimum":1530.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DERMABRASION SEGMENTAL FACE","code_information":[{"code":"15781","type":"CPT"}],"standard_charges":[{"minimum":749.9,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"DERMABRASION OTHER THAN FACE","code_information":[{"code":"15782","type":"CPT"}],"standard_charges":[{"minimum":1530.45,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DERMABRASION SUPRFL ANY SITE","code_information":[{"code":"15783","type":"CPT"}],"standard_charges":[{"minimum":425.83,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"ABRASION LESION SINGLE","code_information":[{"code":"15786","type":"CPT"}],"standard_charges":[{"minimum":162.24,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"CHEMICAL PEEL FACE EPIDERM","code_information":[{"code":"15788","type":"CPT"}],"standard_charges":[{"minimum":228.87,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"CHEMICAL PEEL FACE DERMAL","code_information":[{"code":"15789","type":"CPT"}],"standard_charges":[{"minimum":432.72,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CHEMICAL PEEL NONFACIAL","code_information":[{"code":"15792","type":"CPT"}],"standard_charges":[{"minimum":222.44,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"CHEMICAL PEEL NONFACIAL","code_information":[{"code":"15793","type":"CPT"}],"standard_charges":[{"minimum":376.93,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"REVISION OF LOWER EYELID","code_information":[{"code":"15820","type":"CPT"}],"standard_charges":[{"minimum":1949.63,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REVISION OF LOWER EYELID","code_information":[{"code":"15821","type":"CPT"}],"standard_charges":[{"minimum":1949.63,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REVISION OF UPPER EYELID","code_information":[{"code":"15822","type":"CPT"}],"standard_charges":[{"minimum":1949.63,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REVISION OF UPPER EYELID","code_information":[{"code":"15823","type":"CPT"}],"standard_charges":[{"minimum":579.7,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOREHEAD WRINKLES","code_information":[{"code":"15824","type":"CPT"}],"standard_charges":[{"minimum":1949.63,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NECK WRINKLES","code_information":[{"code":"15825","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BROW WRINKLES","code_information":[{"code":"15826","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FACE WRINKLES","code_information":[{"code":"15828","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SKIN WRINKLES","code_information":[{"code":"15829","type":"CPT"}],"standard_charges":[{"minimum":2788,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"EXC SKIN ABD","code_information":[{"code":"15830","type":"CPT"}],"standard_charges":[{"minimum":1227.7,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1227.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1227.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1227.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"EXCISE EXCESSIVE SKIN THIGH","code_information":[{"code":"15832","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXCISE EXCESSIVE SKIN LEG","code_information":[{"code":"15833","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXCISE EXCESSIVE SKIN HIP","code_information":[{"code":"15834","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXCISE EXCESSIVE SKIN BUTTCK","code_information":[{"code":"15835","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXCISE EXCESSIVE SKIN ARM","code_information":[{"code":"15836","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXCISE EXCESS SKIN ARM/HAND","code_information":[{"code":"15837","type":"CPT"}],"standard_charges":[{"minimum":2405,"maximum":4392.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXCISE EXCESS SKIN FAT PAD","code_information":[{"code":"15838","type":"CPT"}],"standard_charges":[{"minimum":2405,"maximum":4392.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXCISE EXCESS SKIN  TISSUE","code_information":[{"code":"15839","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"NERVE PALSY FASCIAL GRAFT","code_information":[{"code":"15840","type":"CPT"}],"standard_charges":[{"minimum":1062.48,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"NERVE PALSY MUSCLE GRAFT","code_information":[{"code":"15841","type":"CPT"}],"standard_charges":[{"minimum":1860.68,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1860.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1860.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1860.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"NERVE PALSY MICROSURG GRAFT","code_information":[{"code":"15842","type":"CPT"}],"standard_charges":[{"minimum":1949.63,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2814.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2814.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2814.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SKIN AND MUSCLE REPAIR FACE","code_information":[{"code":"15845","type":"CPT"}],"standard_charges":[{"minimum":1115.05,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"EXC SKIN ABD ADD-ON","code_information":[{"code":"15847","type":"CPT"}],"standard_charges":[{"minimum":378.49,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.49,"methodology":"fee schedule"}]}]},{"description":"REMOVE SUTURES DIFF SURGEON","code_information":[{"code":"15851","type":"CPT"}],"standard_charges":[{"minimum":68.3,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"DRESSING CHANGE NOT FOR BURN","code_information":[{"code":"15852","type":"CPT"}],"standard_charges":[{"minimum":46.49,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"TEST FOR BLOOD FLOW IN GRAFT","code_information":[{"code":"15860","type":"CPT"}],"standard_charges":[{"minimum":110.15,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":520.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":390.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":390.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"SUCTION LIPECTOMY HEADNECK","code_information":[{"code":"15876","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"SUCTION LIPECTOMY TRUNK","code_information":[{"code":"15877","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"SUCTION LIPECTOMY UPR EXTREM","code_information":[{"code":"15878","type":"CPT"}],"standard_charges":[{"minimum":1949.63,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SUCTION LIPECTOMY LWR EXTREM","code_information":[{"code":"15879","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TAIL BONE ULCER","code_information":[{"code":"15920","type":"CPT"}],"standard_charges":[{"minimum":663.38,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TAIL BONE ULCER","code_information":[{"code":"15922","type":"CPT"}],"standard_charges":[{"minimum":838.61,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15931","type":"CPT"}],"standard_charges":[{"minimum":739.55,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15933","type":"CPT"}],"standard_charges":[{"minimum":916.57,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15934","type":"CPT"}],"standard_charges":[{"minimum":1034.23,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15935","type":"CPT"}],"standard_charges":[{"minimum":1212.68,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15936","type":"CPT"}],"standard_charges":[{"minimum":941.25,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15937","type":"CPT"}],"standard_charges":[{"minimum":1086.44,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1086.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1086.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1086.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15940","type":"CPT"}],"standard_charges":[{"minimum":744.92,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15941","type":"CPT"}],"standard_charges":[{"minimum":974.86,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15944","type":"CPT"}],"standard_charges":[{"minimum":981.66,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15945","type":"CPT"}],"standard_charges":[{"minimum":1071.78,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15946","type":"CPT"}],"standard_charges":[{"minimum":1686.16,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15950","type":"CPT"}],"standard_charges":[{"minimum":670.53,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15951","type":"CPT"}],"standard_charges":[{"minimum":944.82,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":944.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":944.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":944.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15952","type":"CPT"}],"standard_charges":[{"minimum":962.7,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15953","type":"CPT"}],"standard_charges":[{"minimum":1060.33,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15956","type":"CPT"}],"standard_charges":[{"minimum":1243.43,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15958","type":"CPT"}],"standard_charges":[{"minimum":1231.63,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1231.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1231.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1231.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PRESSURE SORE","code_information":[{"code":"15999","type":"CPT"}],"standard_charges":[{"minimum":462.2,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"INITIAL TREATMENT OF BURN(S)","code_information":[{"code":"16000","type":"CPT"}],"standard_charges":[{"minimum":47.56,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DRESS/DEBRID P-THICK BURN S","code_information":[{"code":"16020","type":"CPT"}],"standard_charges":[{"minimum":58.65,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DRESS/DEBRID P-THICK BURN M","code_information":[{"code":"16025","type":"CPT"}],"standard_charges":[{"minimum":116.58,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DRESS/DEBRID P-THICK BURN L","code_information":[{"code":"16030","type":"CPT"}],"standard_charges":[{"minimum":137.68,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"INCISION OF BURN SCAB INITI","code_information":[{"code":"16035","type":"CPT"}],"standard_charges":[{"minimum":204.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"ESCHAROTOMY ADDL INCISION","code_information":[{"code":"16036","type":"CPT"}],"standard_charges":[{"minimum":85.47,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"}]}]},{"description":"DESTRUCT PREMALG LESION","code_information":[{"code":"17000","type":"CPT"}],"standard_charges":[{"minimum":58.29,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCT PREMALG LES 2-14","code_information":[{"code":"17003","type":"CPT"}],"standard_charges":[{"minimum":2.15,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"}]}]},{"description":"DESTROY PREMAL LESIONS 15/>","code_information":[{"code":"17004","type":"CPT"}],"standard_charges":[{"minimum":103.35,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17106","type":"CPT"}],"standard_charges":[{"minimum":291.1,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17107","type":"CPT"}],"standard_charges":[{"minimum":379.07,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17108","type":"CPT"}],"standard_charges":[{"minimum":555.38,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"DESTRUCT B9 LESION 1-14","code_information":[{"code":"17110","type":"CPT"}],"standard_charges":[{"minimum":72.6,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCT LESION 15 OR MORE","code_information":[{"code":"17111","type":"CPT"}],"standard_charges":[{"minimum":87.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"CHEM CAUT OF GRANLTJ TISSUE","code_information":[{"code":"17250","type":"CPT"}],"standard_charges":[{"minimum":39.34,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17260","type":"CPT"}],"standard_charges":[{"minimum":74.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17261","type":"CPT"}],"standard_charges":[{"minimum":91.91,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17262","type":"CPT"}],"standard_charges":[{"minimum":116.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17263","type":"CPT"}],"standard_charges":[{"minimum":128.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17264","type":"CPT"}],"standard_charges":[{"minimum":137.32,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17266","type":"CPT"}],"standard_charges":[{"minimum":160.93,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17270","type":"CPT"}],"standard_charges":[{"minimum":100.49,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17271","type":"CPT"}],"standard_charges":[{"minimum":110.5,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17272","type":"CPT"}],"standard_charges":[{"minimum":127.31,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17273","type":"CPT"}],"standard_charges":[{"minimum":143.76,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17274","type":"CPT"}],"standard_charges":[{"minimum":175.59,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17276","type":"CPT"}],"standard_charges":[{"minimum":211.71,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17280","type":"CPT"}],"standard_charges":[{"minimum":91.55,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17281","type":"CPT"}],"standard_charges":[{"minimum":124.09,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17282","type":"CPT"}],"standard_charges":[{"minimum":143.05,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17283","type":"CPT"}],"standard_charges":[{"minimum":178.81,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17284","type":"CPT"}],"standard_charges":[{"minimum":208.13,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17286","type":"CPT"}],"standard_charges":[{"minimum":282.52,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"MOHS 1 STAGE H/N/HF/G","code_information":[{"code":"17311","type":"CPT"}],"standard_charges":[{"minimum":369.42,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"MOHS ADDL STAGE","code_information":[{"code":"17312","type":"CPT"}],"standard_charges":[{"minimum":196.69,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"}]}]},{"description":"MOHS 1 STAGE T/A/L","code_information":[{"code":"17313","type":"CPT"}],"standard_charges":[{"minimum":331.51,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"MOHS ADDL STAGE T/A/L","code_information":[{"code":"17314","type":"CPT"}],"standard_charges":[{"minimum":182.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"}]}]},{"description":"MOHS SURG ADDL BLOCK","code_information":[{"code":"17315","type":"CPT"}],"standard_charges":[{"minimum":51.85,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"}]}]},{"description":"CRYOTHERAPY OF SKIN","code_information":[{"code":"17340","type":"CPT"}],"standard_charges":[{"minimum":51.5,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"SKIN PEEL THERAPY","code_information":[{"code":"17360","type":"CPT"}],"standard_charges":[{"minimum":162.24,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"HAIR REMOVAL BY ELECTROLYSIS","code_information":[{"code":"17380","type":"CPT"}],"standard_charges":[{"minimum":652.42,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"SKIN TISSUE PROCEDURE","code_information":[{"code":"17999","type":"CPT"}],"standard_charges":[{"minimum":133.42,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF BREAST LESION","code_information":[{"code":"19000","type":"CPT"}],"standard_charges":[{"minimum":43.99,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"DRAIN BREAST LESION ADD-ON","code_information":[{"code":"19001","type":"CPT"}],"standard_charges":[{"minimum":21.81,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"}]}]},{"description":"INCISION OF BREAST LESION","code_information":[{"code":"19020","type":"CPT"}],"standard_charges":[{"minimum":331.51,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR BREAST X-RAY","code_information":[{"code":"19030","type":"CPT"}],"standard_charges":[{"minimum":78.32,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"}]}]},{"description":"BX BREAST 1ST LESION STRTCTC","code_information":[{"code":"19081","type":"CPT"}],"standard_charges":[{"minimum":168.44,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BX BREAST ADD LESION STRTCTC","code_information":[{"code":"19082","type":"CPT"}],"standard_charges":[{"minimum":84.4,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"}]}]},{"description":"BX BREAST 1ST LESION US IMAG","code_information":[{"code":"19083","type":"CPT"}],"standard_charges":[{"minimum":159.14,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BX BREAST ADD LESION US IMAG","code_information":[{"code":"19084","type":"CPT"}],"standard_charges":[{"minimum":79.39,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"}]}]},{"description":"BX BREAST 1ST LESION MR IMAG","code_information":[{"code":"19085","type":"CPT"}],"standard_charges":[{"minimum":185.25,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BX BREAST ADD LESION MR IMAG","code_information":[{"code":"19086","type":"CPT"}],"standard_charges":[{"minimum":92.27,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"}]}]},{"description":"BX BREAST PERCUT W/O IMAGE","code_information":[{"code":"19100","type":"CPT"}],"standard_charges":[{"minimum":71.52,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF BREAST OPEN","code_information":[{"code":"19101","type":"CPT"}],"standard_charges":[{"minimum":234.6,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"CRYOSURG ABLATE FA EACH","code_information":[{"code":"19105","type":"CPT"}],"standard_charges":[{"minimum":217.79,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"NIPPLE EXPLORATION","code_information":[{"code":"19110","type":"CPT"}],"standard_charges":[{"minimum":372.28,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"EXCISE BREAST DUCT FISTULA","code_information":[{"code":"19112","type":"CPT"}],"standard_charges":[{"minimum":341.52,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BREAST LESION","code_information":[{"code":"19120","type":"CPT"}],"standard_charges":[{"minimum":440.23,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"EXCISION BREAST LESION","code_information":[{"code":"19125","type":"CPT"}],"standard_charges":[{"minimum":486.72,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"EXCISION ADDL BREAST LESION","code_information":[{"code":"19126","type":"CPT"}],"standard_charges":[{"minimum":165.58,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"}]}]},{"description":"PERQ DEVICE BREAST 1ST IMAG","code_information":[{"code":"19281","type":"CPT"}],"standard_charges":[{"minimum":101.92,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"PERQ DEVICE BREAST EA IMAG","code_information":[{"code":"19282","type":"CPT"}],"standard_charges":[{"minimum":51.14,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV BREAST 1ST STRTCTC","code_information":[{"code":"19283","type":"CPT"}],"standard_charges":[{"minimum":102.64,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV BREAST ADD STRTCTC","code_information":[{"code":"19284","type":"CPT"}],"standard_charges":[{"minimum":51.5,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.5,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV BREAST 1ST US IMAG","code_information":[{"code":"19285","type":"CPT"}],"standard_charges":[{"minimum":86.9,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV BREAST ADD US IMAG","code_information":[{"code":"19286","type":"CPT"}],"standard_charges":[{"minimum":43.63,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV BREAST 1ST MR GUIDE","code_information":[{"code":"19287","type":"CPT"}],"standard_charges":[{"minimum":129.81,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"PERQ DEV BREAST ADD MR GUIDE","code_information":[{"code":"19288","type":"CPT"}],"standard_charges":[{"minimum":64.73,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.73,"methodology":"fee schedule"}]}]},{"description":"PREP TUM CAV IORT PRTL MAST","code_information":[{"code":"19294","type":"CPT"}],"standard_charges":[{"minimum":169.87,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"}]}]},{"description":"PLACE PO BREAST CATH FOR RAD","code_information":[{"code":"19296","type":"CPT"}],"standard_charges":[{"minimum":218.15,"maximum":10504.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10300.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10504.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10402.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10453.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"}]}]},{"description":"PLACE BREAST CATH FOR RAD","code_information":[{"code":"19297","type":"CPT"}],"standard_charges":[{"minimum":96.91,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"}]}]},{"description":"PLACE BREAST RAD TUBE/CATHS","code_information":[{"code":"19298","type":"CPT"}],"standard_charges":[{"minimum":332.58,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BREAST TISSUE","code_information":[{"code":"19300","type":"CPT"}],"standard_charges":[{"minimum":455.25,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"PARTIAL MASTECTOMY","code_information":[{"code":"19301","type":"CPT"}],"standard_charges":[{"minimum":693.06,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"P-MASTECTOMY W/LN REMOVAL","code_information":[{"code":"19302","type":"CPT"}],"standard_charges":[{"minimum":951.26,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"MAST SIMPLE COMPLETE","code_information":[{"code":"19303","type":"CPT"}],"standard_charges":[{"minimum":1004.19,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"MAST RADICAL","code_information":[{"code":"19305","type":"CPT"}],"standard_charges":[{"minimum":1204.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.1,"methodology":"fee schedule"}]}]},{"description":"MAST RAD URBAN TYPE","code_information":[{"code":"19306","type":"CPT"}],"standard_charges":[{"minimum":1279.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.2,"methodology":"fee schedule"}]}]},{"description":"MAST MOD RAD","code_information":[{"code":"19307","type":"CPT"}],"standard_charges":[{"minimum":1235.92,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"SUSPENSION OF BREAST","code_information":[{"code":"19316","type":"CPT"}],"standard_charges":[{"minimum":832.53,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"BREAST REDUCTION","code_information":[{"code":"19318","type":"CPT"}],"standard_charges":[{"minimum":1146.16,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"BREAST AUGMENTATION W/IMPLT","code_information":[{"code":"19325","type":"CPT"}],"standard_charges":[{"minimum":648,"maximum":10504.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10300.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10504.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10402.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10453.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BREAST IMPLANT","code_information":[{"code":"19328","type":"CPT"}],"standard_charges":[{"minimum":583.27,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF IMPLANT MATERIAL","code_information":[{"code":"19330","type":"CPT"}],"standard_charges":[{"minimum":679.11,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":679.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":679.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":679.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"IMMEDIATE BREAST PROSTHESIS","code_information":[{"code":"19340","type":"CPT"}],"standard_charges":[{"minimum":797.84,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"DELAYED BREAST PROSTHESIS","code_information":[{"code":"19342","type":"CPT"}],"standard_charges":[{"minimum":800.35,"maximum":10504.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10300.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10504.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10402.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10453.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10198.88,"methodology":"fee schedule"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19350","type":"CPT"}],"standard_charges":[{"minimum":708.08,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"CORRECT INVERTED NIPPLE(S)","code_information":[{"code":"19355","type":"CPT"}],"standard_charges":[{"minimum":649.07,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19357","type":"CPT"}],"standard_charges":[{"minimum":1218.4,"maximum":19099.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18543.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18728.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19099.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18914.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18543.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18543.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18543.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19007.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18543.51,"methodology":"fee schedule"}]}]},{"description":"BREAST RECONSTR W/LAT FLAP","code_information":[{"code":"19361","type":"CPT"}],"standard_charges":[{"minimum":1629.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1629.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1629.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1629.66,"methodology":"fee schedule"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19364","type":"CPT"}],"standard_charges":[{"minimum":2835.55,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2835.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2835.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2835.55,"methodology":"fee schedule"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19367","type":"CPT"}],"standard_charges":[{"minimum":1850.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1850.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1850.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1850.31,"methodology":"fee schedule"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19368","type":"CPT"}],"standard_charges":[{"minimum":2263,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2263,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2263,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2263,"methodology":"fee schedule"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19369","type":"CPT"}],"standard_charges":[{"minimum":2103.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.15,"methodology":"fee schedule"}]}]},{"description":"REVJ PERI-IMPLT CAPSULE BRST","code_information":[{"code":"19370","type":"CPT"}],"standard_charges":[{"minimum":707.01,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"PERI-IMPLT CAPSLC BRST COMPL","code_information":[{"code":"19371","type":"CPT"}],"standard_charges":[{"minimum":748.13,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"REVISE BREAST RECONSTRUCTION","code_information":[{"code":"19380","type":"CPT"}],"standard_charges":[{"minimum":848.63,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"DESIGN CUSTOM BREAST IMPLANT","code_information":[{"code":"19396","type":"CPT"}],"standard_charges":[{"minimum":149.13,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"BREAST SURGERY PROCEDURE","code_information":[{"code":"19499","type":"CPT"}],"standard_charges":[{"minimum":2202,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2346.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2346.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2346.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"EXPLORE WOUND NECK","code_information":[{"code":"20100","type":"CPT"}],"standard_charges":[{"minimum":542.77,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"EXPLORE WOUND CHEST","code_information":[{"code":"20101","type":"CPT"}],"standard_charges":[{"minimum":218.86,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"EXPLORE WOUND ABDOMEN","code_information":[{"code":"20102","type":"CPT"}],"standard_charges":[{"minimum":268.21,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"EXPLORE WOUND EXTREMITY","code_information":[{"code":"20103","type":"CPT"}],"standard_charges":[{"minimum":362.27,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXCISE EPIPHYSEAL BAR","code_information":[{"code":"20150","type":"CPT"}],"standard_charges":[{"minimum":1055.69,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"MUSCLE BIOPSY","code_information":[{"code":"20200","type":"CPT"}],"standard_charges":[{"minimum":99.42,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DEEP MUSCLE BIOPSY","code_information":[{"code":"20205","type":"CPT"}],"standard_charges":[{"minimum":161.64,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BIOPSY MUSCLE","code_information":[{"code":"20206","type":"CPT"}],"standard_charges":[{"minimum":59.36,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BONE BIOPSY TROCAR/NEEDLE","code_information":[{"code":"20220","type":"CPT"}],"standard_charges":[{"minimum":90.48,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BONE BIOPSY TROCAR/NEEDLE","code_information":[{"code":"20225","type":"CPT"}],"standard_charges":[{"minimum":134.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BONE BIOPSY OPEN SUPERFICIAL","code_information":[{"code":"20240","type":"CPT"}],"standard_charges":[{"minimum":146.62,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"BONE BIOPSY OPEN DEEP","code_information":[{"code":"20245","type":"CPT"}],"standard_charges":[{"minimum":358.33,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"OPEN BONE BIOPSY","code_information":[{"code":"20250","type":"CPT"}],"standard_charges":[{"minimum":411.26,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"OPEN BONE BIOPSY","code_information":[{"code":"20251","type":"CPT"}],"standard_charges":[{"minimum":439.87,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INJECTION OF SINUS TRACT","code_information":[{"code":"20500","type":"CPT"}],"standard_charges":[{"minimum":94.41,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"INJECT SINUS TRACT FOR X-RAY","code_information":[{"code":"20501","type":"CPT"}],"standard_charges":[{"minimum":37.55,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":217.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":217.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOREIGN BODY","code_information":[{"code":"20520","type":"CPT"}],"standard_charges":[{"minimum":156.28,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOREIGN BODY","code_information":[{"code":"20525","type":"CPT"}],"standard_charges":[{"minimum":259.99,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"THER INJECTION CARP TUNNEL","code_information":[{"code":"20526","type":"CPT"}],"standard_charges":[{"minimum":59.36,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"INJ DUPUYTREN CORD W/ENZYME","code_information":[{"code":"20527","type":"CPT"}],"standard_charges":[{"minimum":68.66,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"INJ TENDON SHEATH/LIGAMENT","code_information":[{"code":"20550","type":"CPT"}],"standard_charges":[{"minimum":40.77,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"INJ TENDON ORIGIN/INSERTION","code_information":[{"code":"20551","type":"CPT"}],"standard_charges":[{"minimum":40.41,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"INJ TRIGGER POINT 1/2 MUSCL","code_information":[{"code":"20552","type":"CPT"}],"standard_charges":[{"minimum":38.62,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":122.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":122.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"INJECT TRIGGER POINTS 3/>","code_information":[{"code":"20553","type":"CPT"}],"standard_charges":[{"minimum":43.99,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":139.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":139.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"PLACE NDL MUSC/TIS FOR RT","code_information":[{"code":"20555","type":"CPT"}],"standard_charges":[{"minimum":351.9,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"NDL INSJ W/O NJX 1 OR 2 MUSC","code_information":[{"code":"20560","type":"CPT"}],"standard_charges":[{"minimum":26.1,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"}]}]},{"description":"NDL INSJ W/O NJX 3+ MUSC","code_information":[{"code":"20561","type":"CPT"}],"standard_charges":[{"minimum":26.1,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":75.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":75.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"}]}]},{"description":"DRAIN/INJ JOINT/BURSA W/O US","code_information":[{"code":"20600","type":"CPT"}],"standard_charges":[{"minimum":37.55,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"DRAIN/INJ JOINT/BURSA W/US","code_information":[{"code":"20604","type":"CPT"}],"standard_charges":[{"minimum":47.92,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"DRAIN/INJ JOINT/BURSA W/O US","code_information":[{"code":"20605","type":"CPT"}],"standard_charges":[{"minimum":38.62,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"DRAIN/INJ JOINT/BURSA W/US","code_information":[{"code":"20606","type":"CPT"}],"standard_charges":[{"minimum":54.36,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"DRAIN/INJ JOINT/BURSA W/O US","code_information":[{"code":"20610","type":"CPT"}],"standard_charges":[{"minimum":47.56,"maximum":9595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"DRAIN/INJ JOINT/BURSA W/US","code_information":[{"code":"20611","type":"CPT"}],"standard_charges":[{"minimum":61.87,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"20612","type":"CPT"}],"standard_charges":[{"minimum":42.91,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1836.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1377.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1377.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF BONE CYST","code_information":[{"code":"20615","type":"CPT"}],"standard_charges":[{"minimum":171.66,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"INSERT AND REMOVE BONE PIN","code_information":[{"code":"20650","type":"CPT"}],"standard_charges":[{"minimum":177.02,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"APPLY REM FIXATION DEVICE","code_information":[{"code":"20660","type":"CPT"}],"standard_charges":[{"minimum":249.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF HEAD BRACE","code_information":[{"code":"20661","type":"CPT"}],"standard_charges":[{"minimum":556.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.45,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF PELVIS BRACE","code_information":[{"code":"20662","type":"CPT"}],"standard_charges":[{"minimum":555.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF THIGH BRACE","code_information":[{"code":"20663","type":"CPT"}],"standard_charges":[{"minimum":512.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF HALO","code_information":[{"code":"20664","type":"CPT"}],"standard_charges":[{"minimum":940.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FIXATION DEVICE","code_information":[{"code":"20665","type":"CPT"}],"standard_charges":[{"minimum":103.35,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SUPPORT IMPLANT","code_information":[{"code":"20670","type":"CPT"}],"standard_charges":[{"minimum":153.06,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SUPPORT IMPLANT","code_information":[{"code":"20680","type":"CPT"}],"standard_charges":[{"minimum":443.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"APPLY BONE FIXATION DEVICE","code_information":[{"code":"20690","type":"CPT"}],"standard_charges":[{"minimum":629.41,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"APPLY BONE FIXATION DEVICE","code_information":[{"code":"20692","type":"CPT"}],"standard_charges":[{"minimum":1190.86,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"ADJUST BONE FIXATION DEVICE","code_information":[{"code":"20693","type":"CPT"}],"standard_charges":[{"minimum":474.56,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE BONE FIXATION DEVICE","code_information":[{"code":"20694","type":"CPT"}],"standard_charges":[{"minimum":363.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"COMP MULTIPLANE EXT FIXATION","code_information":[{"code":"20696","type":"CPT"}],"standard_charges":[{"minimum":1225.91,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"COMP EXT FIXATE STRUT CHANGE","code_information":[{"code":"20697","type":"CPT"}],"standard_charges":[{"minimum":1705.75,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1851.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1851.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1851.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"MNL PREPINSJ DP RX DLVR DEV","code_information":[{"code":"20700","type":"CPT"}],"standard_charges":[{"minimum":87.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"}]}]},{"description":"RMVL DEEP RX DELIVERY DEVICE","code_information":[{"code":"20701","type":"CPT"}],"standard_charges":[{"minimum":66.52,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"}]}]},{"description":"MNL PREPINSJ IMED RX DEV","code_information":[{"code":"20702","type":"CPT"}],"standard_charges":[{"minimum":126.61,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"}]}]},{"description":"RMVL IMED RX DELIVERY DEVICE","code_information":[{"code":"20703","type":"CPT"}],"standard_charges":[{"minimum":108,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"}]}]},{"description":"MNL PREPINSJ I-ARTIC RX DEV","code_information":[{"code":"20704","type":"CPT"}],"standard_charges":[{"minimum":126.61,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"}]}]},{"description":"RMVL I-ARTIC RX DELIVERY DEV","code_information":[{"code":"20705","type":"CPT"}],"standard_charges":[{"minimum":126.61,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"}]}]},{"description":"REPLANTATION ARM COMPLETE","code_information":[{"code":"20802","type":"CPT"}],"standard_charges":[{"minimum":2865.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2865.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2865.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2865.94,"methodology":"fee schedule"}]}]},{"description":"REPLANT FOREARM COMPLETE","code_information":[{"code":"20805","type":"CPT"}],"standard_charges":[{"minimum":3402.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3402.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3402.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3402.01,"methodology":"fee schedule"}]}]},{"description":"REPLANTATION HAND COMPLETE","code_information":[{"code":"20808","type":"CPT"}],"standard_charges":[{"minimum":3431,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4101.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4101.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4101.51,"methodology":"fee schedule"}]}]},{"description":"REPLANTATION DIGIT COMPLETE","code_information":[{"code":"20816","type":"CPT"}],"standard_charges":[{"minimum":2145.7,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2145.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2145.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2145.7,"methodology":"fee schedule"}]}]},{"description":"REPLANTATION DIGIT COMPLETE","code_information":[{"code":"20822","type":"CPT"}],"standard_charges":[{"minimum":1705.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1856.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1856.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1856.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REPLANTATION THUMB COMPLETE","code_information":[{"code":"20824","type":"CPT"}],"standard_charges":[{"minimum":2149.99,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2149.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2149.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2149.99,"methodology":"fee schedule"}]}]},{"description":"REPLANTATION THUMB COMPLETE","code_information":[{"code":"20827","type":"CPT"}],"standard_charges":[{"minimum":1905.38,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1905.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1905.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1905.38,"methodology":"fee schedule"}]}]},{"description":"REPLANTATION FOOT COMPLETE","code_information":[{"code":"20838","type":"CPT"}],"standard_charges":[{"minimum":2908.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2908.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2908.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2908.5,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BONE FOR GRAFT","code_information":[{"code":"20900","type":"CPT"}],"standard_charges":[{"minimum":188.46,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BONE FOR GRAFT","code_information":[{"code":"20902","type":"CPT"}],"standard_charges":[{"minimum":287.17,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE CARTILAGE FOR GRAFT","code_information":[{"code":"20910","type":"CPT"}],"standard_charges":[{"minimum":507.1,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":672,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":665.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":652.42,"methodology":"fee schedule"}]}]},{"description":"REMOVE CARTILAGE FOR GRAFT","code_information":[{"code":"20912","type":"CPT"}],"standard_charges":[{"minimum":511.03,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FASCIA FOR GRAFT","code_information":[{"code":"20920","type":"CPT"}],"standard_charges":[{"minimum":424.49,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FASCIA FOR GRAFT","code_information":[{"code":"20922","type":"CPT"}],"standard_charges":[{"minimum":526.41,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TENDON FOR GRAFT","code_information":[{"code":"20924","type":"CPT"}],"standard_charges":[{"minimum":534.64,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SP BONE ALGRFT MORSEL ADD-ON","code_information":[{"code":"20930","type":"CPT"}],"standard_charges":[{"minimum":1488,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"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":114.08,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.08,"methodology":"fee schedule"}]}]},{"description":"OSTEOART ALGRFT W/SURF  B1","code_information":[{"code":"20932","type":"CPT"}],"standard_charges":[{"minimum":782.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.11,"methodology":"fee schedule"}]}]},{"description":"HEMICRT INTRCLRY ALGRFT PRTL","code_information":[{"code":"20933","type":"CPT"}],"standard_charges":[{"minimum":717.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.38,"methodology":"fee schedule"}]}]},{"description":"INTERCALARY ALGRFT COMPL","code_information":[{"code":"20934","type":"CPT"}],"standard_charges":[{"minimum":781.39,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.39,"methodology":"fee schedule"}]}]},{"description":"SP BONE AGRFT LOCAL ADD-ON","code_information":[{"code":"20936","type":"CPT"}],"standard_charges":[{"minimum":2202,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"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":172.73,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.73,"methodology":"fee schedule"}]}]},{"description":"SP BONE AGRFT STRUCT ADD-ON","code_information":[{"code":"20938","type":"CPT"}],"standard_charges":[{"minimum":189.89,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"}]}]},{"description":"BONE MARROW ASPIR BONE GRFG","code_information":[{"code":"20939","type":"CPT"}],"standard_charges":[{"minimum":72.24,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"}]}]},{"description":"FLUID PRESSURE MUSCLE","code_information":[{"code":"20950","type":"CPT"}],"standard_charges":[{"minimum":92.98,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"FIBULA BONE GRAFT MICROVASC","code_information":[{"code":"20955","type":"CPT"}],"standard_charges":[{"minimum":2553.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2553.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2553.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2553.74,"methodology":"fee schedule"}]}]},{"description":"ILIAC BONE GRAFT MICROVASC","code_information":[{"code":"20956","type":"CPT"}],"standard_charges":[{"minimum":2755.44,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2755.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2755.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2755.44,"methodology":"fee schedule"}]}]},{"description":"MT BONE GRAFT MICROVASC","code_information":[{"code":"20957","type":"CPT"}],"standard_charges":[{"minimum":2871.31,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2871.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2871.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2871.31,"methodology":"fee schedule"}]}]},{"description":"OTHER BONE GRAFT MICROVASC","code_information":[{"code":"20962","type":"CPT"}],"standard_charges":[{"minimum":2794.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2794.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2794.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2794.06,"methodology":"fee schedule"}]}]},{"description":"BONE/SKIN GRAFT MICROVASC","code_information":[{"code":"20969","type":"CPT"}],"standard_charges":[{"minimum":2839.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2839.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2839.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2839.48,"methodology":"fee schedule"}]}]},{"description":"BONE/SKIN GRAFT ILIAC CREST","code_information":[{"code":"20970","type":"CPT"}],"standard_charges":[{"minimum":2972.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2972.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2972.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2972.51,"methodology":"fee schedule"}]}]},{"description":"BONE/SKIN GRAFT METATARSAL","code_information":[{"code":"20972","type":"CPT"}],"standard_charges":[{"minimum":2963.57,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2963.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2963.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2963.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"BONE/SKIN GRAFT GREAT TOE","code_information":[{"code":"20973","type":"CPT"}],"standard_charges":[{"minimum":3129.86,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3129.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3129.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3129.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"ELECTRICAL BONE STIMULATION","code_information":[{"code":"20974","type":"CPT"}],"standard_charges":[{"minimum":53.64,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":243.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":243.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":81.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":82.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":84.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":83.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":81.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":81.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":81.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":83.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":81.87,"methodology":"fee schedule"}]}]},{"description":"ELECTRICAL BONE STIMULATION","code_information":[{"code":"20975","type":"CPT"}],"standard_charges":[{"minimum":183.82,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.82,"methodology":"fee schedule"}]}]},{"description":"US BONE STIMULATION","code_information":[{"code":"20979","type":"CPT"}],"standard_charges":[{"minimum":26.1,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"}]}]},{"description":"ABLATE BONE TUMOR(S) PERQ","code_information":[{"code":"20982","type":"CPT"}],"standard_charges":[{"minimum":378.72,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"ABLATE BONE TUMOR(S) PERQ","code_information":[{"code":"20983","type":"CPT"}],"standard_charges":[{"minimum":353.68,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"MUSCULOSKELETAL SURGERY","code_information":[{"code":"20999","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"INCISION OF JAW JOINT","code_information":[{"code":"21010","type":"CPT"}],"standard_charges":[{"minimum":779.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXC FACE LES SC <2 CM","code_information":[{"code":"21011","type":"CPT"}],"standard_charges":[{"minimum":276.44,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC FACE LES SBQ 2 CM/>","code_information":[{"code":"21012","type":"CPT"}],"standard_charges":[{"minimum":358.69,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC FACE TUM DEEP < 2 CM","code_information":[{"code":"21013","type":"CPT"}],"standard_charges":[{"minimum":425.21,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC FACE TUM DEEP 2 CM/>","code_information":[{"code":"21014","type":"CPT"}],"standard_charges":[{"minimum":550.73,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT FACE/SCALP TUM < 2 CM","code_information":[{"code":"21015","type":"CPT"}],"standard_charges":[{"minimum":735.26,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT FACE/SCALP TUM 2 CM/>","code_information":[{"code":"21016","type":"CPT"}],"standard_charges":[{"minimum":1057.47,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF BONE LOWER JAW","code_information":[{"code":"21025","type":"CPT"}],"standard_charges":[{"minimum":697.71,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":697.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":697.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":697.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF FACIAL BONE(S)","code_information":[{"code":"21026","type":"CPT"}],"standard_charges":[{"minimum":452.74,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"CONTOUR OF FACE BONE LESION","code_information":[{"code":"21029","type":"CPT"}],"standard_charges":[{"minimum":659.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISE MAX/ZYGOMA B9 TUMOR","code_information":[{"code":"21030","type":"CPT"}],"standard_charges":[{"minimum":380.15,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE EXOSTOSIS MANDIBLE","code_information":[{"code":"21031","type":"CPT"}],"standard_charges":[{"minimum":287.52,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVE EXOSTOSIS MAXILLA","code_information":[{"code":"21032","type":"CPT"}],"standard_charges":[{"minimum":275.01,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISE MAX/ZYGOMA MAL TUMOR","code_information":[{"code":"21034","type":"CPT"}],"standard_charges":[{"minimum":1183.35,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE MANDIBLE LESION","code_information":[{"code":"21040","type":"CPT"}],"standard_charges":[{"minimum":381.58,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF JAW BONE LESION","code_information":[{"code":"21044","type":"CPT"}],"standard_charges":[{"minimum":908.35,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":908.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":908.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":908.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE JAW SURGERY","code_information":[{"code":"21045","type":"CPT"}],"standard_charges":[{"minimum":1260.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1260.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1260.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1260.24,"methodology":"fee schedule"}]}]},{"description":"REMOVE MANDIBLE CYST COMPLEX","code_information":[{"code":"21046","type":"CPT"}],"standard_charges":[{"minimum":1037.45,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1037.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1037.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1037.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE LWR JAW CYST W/REPAIR","code_information":[{"code":"21047","type":"CPT"}],"standard_charges":[{"minimum":1270.97,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE MAXILLA CYST COMPLEX","code_information":[{"code":"21048","type":"CPT"}],"standard_charges":[{"minimum":1046.74,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCIS UPPR JAW CYST W/REPAIR","code_information":[{"code":"21049","type":"CPT"}],"standard_charges":[{"minimum":1207.67,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1207.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1207.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1207.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF JAW JOINT","code_information":[{"code":"21050","type":"CPT"}],"standard_charges":[{"minimum":906.92,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE JAW JOINT CARTILAGE","code_information":[{"code":"21060","type":"CPT"}],"standard_charges":[{"minimum":822.16,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE CORONOID PROCESS","code_information":[{"code":"21070","type":"CPT"}],"standard_charges":[{"minimum":645.86,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"MNPJ OF TMJ W/ANESTH","code_information":[{"code":"21073","type":"CPT"}],"standard_charges":[{"minimum":252.84,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21076","type":"CPT"}],"standard_charges":[{"minimum":740.98,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21077","type":"CPT"}],"standard_charges":[{"minimum":1530.45,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1823.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1823.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1823.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21079","type":"CPT"}],"standard_charges":[{"minimum":1225.91,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21080","type":"CPT"}],"standard_charges":[{"minimum":1382.9,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21081","type":"CPT"}],"standard_charges":[{"minimum":1269.54,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1269.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1269.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1269.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21082","type":"CPT"}],"standard_charges":[{"minimum":1170.84,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1170.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1170.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1170.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21083","type":"CPT"}],"standard_charges":[{"minimum":1082.51,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1082.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1082.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1082.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21084","type":"CPT"}],"standard_charges":[{"minimum":1252.37,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21085","type":"CPT"}],"standard_charges":[{"minimum":247.5,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21086","type":"CPT"}],"standard_charges":[{"minimum":1343.92,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21087","type":"CPT"}],"standard_charges":[{"minimum":1343.92,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21088","type":"CPT"}],"standard_charges":[{"minimum":1530.45,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21089","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"MAXILLOFACIAL FIXATION","code_information":[{"code":"21100","type":"CPT"}],"standard_charges":[{"minimum":376.21,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"INTERDENTAL FIXATION","code_information":[{"code":"21110","type":"CPT"}],"standard_charges":[{"minimum":746.35,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"INJECTION JAW JOINT X-RAY","code_information":[{"code":"21116","type":"CPT"}],"standard_charges":[{"minimum":46.49,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":225.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":225.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21120","type":"CPT"}],"standard_charges":[{"minimum":534.28,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21121","type":"CPT"}],"standard_charges":[{"minimum":558.24,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21122","type":"CPT"}],"standard_charges":[{"minimum":785.68,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21123","type":"CPT"}],"standard_charges":[{"minimum":886.53,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"AUGMENTATION LOWER JAW BONE","code_information":[{"code":"21125","type":"CPT"}],"standard_charges":[{"minimum":702.72,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"AUGMENTATION LOWER JAW BONE","code_information":[{"code":"21127","type":"CPT"}],"standard_charges":[{"minimum":813.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21137","type":"CPT"}],"standard_charges":[{"minimum":789.26,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21138","type":"CPT"}],"standard_charges":[{"minimum":959.84,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21139","type":"CPT"}],"standard_charges":[{"minimum":1141.51,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LEFORT I-1 PIECE W/O GRAFT","code_information":[{"code":"21141","type":"CPT"}],"standard_charges":[{"minimum":1394.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1394.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1394.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1394.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LEFORT I-2 PIECE W/O GRAFT","code_information":[{"code":"21142","type":"CPT"}],"standard_charges":[{"minimum":1431.18,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1431.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1431.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1431.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LEFORT I-3/> PIECE W/O GRAFT","code_information":[{"code":"21143","type":"CPT"}],"standard_charges":[{"minimum":1475.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LEFORT I-1 PIECE W/ GRAFT","code_information":[{"code":"21145","type":"CPT"}],"standard_charges":[{"minimum":1620.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1620.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1620.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1620.72,"methodology":"fee schedule"}]}]},{"description":"LEFORT I-2 PIECE W/ GRAFT","code_information":[{"code":"21146","type":"CPT"}],"standard_charges":[{"minimum":1692.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1692.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1692.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1692.6,"methodology":"fee schedule"}]}]},{"description":"LEFORT I-3/> PIECE W/ GRAFT","code_information":[{"code":"21147","type":"CPT"}],"standard_charges":[{"minimum":1780.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780.22,"methodology":"fee schedule"}]}]},{"description":"LEFORT II ANTERIOR INTRUSION","code_information":[{"code":"21150","type":"CPT"}],"standard_charges":[{"minimum":1724.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1724.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1724.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1724.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LEFORT II W/BONE GRAFTS","code_information":[{"code":"21151","type":"CPT"}],"standard_charges":[{"minimum":1897.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1897.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1897.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1897.52,"methodology":"fee schedule"}]}]},{"description":"LEFORT III W/O LEFORT I","code_information":[{"code":"21154","type":"CPT"}],"standard_charges":[{"minimum":2042.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2042.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2042.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2042.35,"methodology":"fee schedule"}]}]},{"description":"LEFORT III W/ LEFORT I","code_information":[{"code":"21155","type":"CPT"}],"standard_charges":[{"minimum":2265.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2265.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2265.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2265.15,"methodology":"fee schedule"}]}]},{"description":"LEFORT III W/FHDW/O LEFORT I","code_information":[{"code":"21159","type":"CPT"}],"standard_charges":[{"minimum":2712.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2712.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2712.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2712.17,"methodology":"fee schedule"}]}]},{"description":"LEFORT III W/FHD W/ LEFORT I","code_information":[{"code":"21160","type":"CPT"}],"standard_charges":[{"minimum":2941.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2941.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2941.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2941.04,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ORBIT/FOREHEAD","code_information":[{"code":"21172","type":"CPT"}],"standard_charges":[{"minimum":2217.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ORBIT/FOREHEAD","code_information":[{"code":"21175","type":"CPT"}],"standard_charges":[{"minimum":2304.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ENTIRE FOREHEAD","code_information":[{"code":"21179","type":"CPT"}],"standard_charges":[{"minimum":1588.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.18,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ENTIRE FOREHEAD","code_information":[{"code":"21180","type":"CPT"}],"standard_charges":[{"minimum":1772.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1772.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1772.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1772.71,"methodology":"fee schedule"}]}]},{"description":"CONTOUR CRANIAL BONE LESION","code_information":[{"code":"21181","type":"CPT"}],"standard_charges":[{"minimum":778.53,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CRANIAL BONE","code_information":[{"code":"21182","type":"CPT"}],"standard_charges":[{"minimum":2206.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2206.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2206.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2206.5,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CRANIAL BONE","code_information":[{"code":"21183","type":"CPT"}],"standard_charges":[{"minimum":2399.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2399.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2399.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2399.25,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CRANIAL BONE","code_information":[{"code":"21184","type":"CPT"}],"standard_charges":[{"minimum":2580.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2580.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2580.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2580.56,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF MIDFACE","code_information":[{"code":"21188","type":"CPT"}],"standard_charges":[{"minimum":1651.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.12,"methodology":"fee schedule"}]}]},{"description":"RECONST LWR JAW W/O GRAFT","code_information":[{"code":"21193","type":"CPT"}],"standard_charges":[{"minimum":1288.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1288.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1288.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1288.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONST LWR JAW W/GRAFT","code_information":[{"code":"21194","type":"CPT"}],"standard_charges":[{"minimum":1489.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONST LWR JAW W/O FIXATION","code_information":[{"code":"21195","type":"CPT"}],"standard_charges":[{"minimum":1401.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1401.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1401.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1401.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONST LWR JAW W/FIXATION","code_information":[{"code":"21196","type":"CPT"}],"standard_charges":[{"minimum":1496.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1496.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1496.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1496.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTR LWR JAW SEGMENT","code_information":[{"code":"21198","type":"CPT"}],"standard_charges":[{"minimum":1058.9,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTR LWR JAW W/ADVANCE","code_information":[{"code":"21199","type":"CPT"}],"standard_charges":[{"minimum":1064.27,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT UPPER JAW BONE","code_information":[{"code":"21206","type":"CPT"}],"standard_charges":[{"minimum":1018.49,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1018.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1018.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1018.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"AUGMENTATION OF FACIAL BONES","code_information":[{"code":"21208","type":"CPT"}],"standard_charges":[{"minimum":775.67,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REDUCTION OF FACIAL BONES","code_information":[{"code":"21209","type":"CPT"}],"standard_charges":[{"minimum":638.35,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"FACE BONE GRAFT","code_information":[{"code":"21210","type":"CPT"}],"standard_charges":[{"minimum":798.2,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LOWER JAW BONE GRAFT","code_information":[{"code":"21215","type":"CPT"}],"standard_charges":[{"minimum":829.67,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RIB CARTILAGE GRAFT","code_information":[{"code":"21230","type":"CPT"}],"standard_charges":[{"minimum":786.4,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EAR CARTILAGE GRAFT","code_information":[{"code":"21235","type":"CPT"}],"standard_charges":[{"minimum":603.3,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21240","type":"CPT"}],"standard_charges":[{"minimum":1098.24,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21242","type":"CPT"}],"standard_charges":[{"minimum":1061.41,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21243","type":"CPT"}],"standard_charges":[{"minimum":1756.26,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1756.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1756.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1756.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF LOWER JAW","code_information":[{"code":"21244","type":"CPT"}],"standard_charges":[{"minimum":1058.19,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21245","type":"CPT"}],"standard_charges":[{"minimum":992.03,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21246","type":"CPT"}],"standard_charges":[{"minimum":890.11,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT LOWER JAW BONE","code_information":[{"code":"21247","type":"CPT"}],"standard_charges":[{"minimum":1652.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1652.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1652.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1652.91,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21248","type":"CPT"}],"standard_charges":[{"minimum":833.61,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21249","type":"CPT"}],"standard_charges":[{"minimum":1164.4,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT LOWER JAW BONE","code_information":[{"code":"21255","type":"CPT"}],"standard_charges":[{"minimum":1397.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF ORBIT","code_information":[{"code":"21256","type":"CPT"}],"standard_charges":[{"minimum":1299.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1299.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1299.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1299.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21260","type":"CPT"}],"standard_charges":[{"minimum":1430.83,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21261","type":"CPT"}],"standard_charges":[{"minimum":2532.64,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2532.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2532.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2532.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21263","type":"CPT"}],"standard_charges":[{"minimum":2343.11,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2343.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2343.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2343.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21267","type":"CPT"}],"standard_charges":[{"minimum":1673.29,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1673.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1673.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1673.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21268","type":"CPT"}],"standard_charges":[{"minimum":2099.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2099.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2099.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2099.57,"methodology":"fee schedule"}]}]},{"description":"AUGMENTATION CHEEK BONE","code_information":[{"code":"21270","type":"CPT"}],"standard_charges":[{"minimum":785.33,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION ORBITOFACIAL BONES","code_information":[{"code":"21275","type":"CPT"}],"standard_charges":[{"minimum":885.82,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"21280","type":"CPT"}],"standard_charges":[{"minimum":620.47,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"21282","type":"CPT"}],"standard_charges":[{"minimum":421.99,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":421.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":421.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":421.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REVISION OF JAW MUSCLE/BONE","code_information":[{"code":"21295","type":"CPT"}],"standard_charges":[{"minimum":209.92,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REVISION OF JAW MUSCLE/BONE","code_information":[{"code":"21296","type":"CPT"}],"standard_charges":[{"minimum":432.36,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"CRANIO/MAXILLOFACIAL SURGERY","code_information":[{"code":"21299","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"CLOSED TX NOSE FX W/O STABLJ","code_information":[{"code":"21315","type":"CPT"}],"standard_charges":[{"minimum":62.58,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"CLOSED TX NOSE FX W/ STABLJ","code_information":[{"code":"21320","type":"CPT"}],"standard_charges":[{"minimum":99.78,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"OPEN TX NOSE FX UNCOMPLICATD","code_information":[{"code":"21325","type":"CPT"}],"standard_charges":[{"minimum":470.27,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"OPEN TX NOSE FX W/SKELE FIXJ","code_information":[{"code":"21330","type":"CPT"}],"standard_charges":[{"minimum":565.03,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPEN TX NOSE  SEPTAL FX","code_information":[{"code":"21335","type":"CPT"}],"standard_charges":[{"minimum":756.72,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"OPEN TX SEPTAL FX W/WO STABJ","code_information":[{"code":"21336","type":"CPT"}],"standard_charges":[{"minimum":672.32,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CLOSED TX SEPTALNOSE FX","code_information":[{"code":"21337","type":"CPT"}],"standard_charges":[{"minimum":319.35,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"OPEN NASOETHMOID FX W/O FIXJ","code_information":[{"code":"21338","type":"CPT"}],"standard_charges":[{"minimum":707.37,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPEN NASOETHMOID FX W/ FIXJ","code_information":[{"code":"21339","type":"CPT"}],"standard_charges":[{"minimum":798.92,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PERQ TX NASOETHMOID FX","code_information":[{"code":"21340","type":"CPT"}],"standard_charges":[{"minimum":796.06,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"OPEN TX DPRSD FRONT SINUS FX","code_information":[{"code":"21343","type":"CPT"}],"standard_charges":[{"minimum":1146.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"}]}]},{"description":"OPEN TX COMPL FRONT SINUS FX","code_information":[{"code":"21344","type":"CPT"}],"standard_charges":[{"minimum":1464.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1464.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1464.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1464.44,"methodology":"fee schedule"}]}]},{"description":"CLOSED TX NOSE/JAW FX","code_information":[{"code":"21345","type":"CPT"}],"standard_charges":[{"minimum":678.76,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"OPN TX NASOMAX FX W/FIXJ","code_information":[{"code":"21346","type":"CPT"}],"standard_charges":[{"minimum":1074.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX NASOMAX FX MULTPLE","code_information":[{"code":"21347","type":"CPT"}],"standard_charges":[{"minimum":1091.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1091.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1091.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1091.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX NASOMAX FX W/GRAFT","code_information":[{"code":"21348","type":"CPT"}],"standard_charges":[{"minimum":1152.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.96,"methodology":"fee schedule"}]}]},{"description":"PERQ TX MALAR FRACTURE","code_information":[{"code":"21355","type":"CPT"}],"standard_charges":[{"minimum":348.68,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"OPN TX DPRSD ZYGOMATIC ARCH","code_information":[{"code":"21356","type":"CPT"}],"standard_charges":[{"minimum":425.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX DPRSD MALAR FRACTURE","code_information":[{"code":"21360","type":"CPT"}],"standard_charges":[{"minimum":557.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX COMPLX MALAR FX","code_information":[{"code":"21365","type":"CPT"}],"standard_charges":[{"minimum":1134,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX COMPLX MALAR W/GRFT","code_information":[{"code":"21366","type":"CPT"}],"standard_charges":[{"minimum":1336.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1336.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1336.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1336.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX ORBIT FX TRANSANTRAL","code_information":[{"code":"21385","type":"CPT"}],"standard_charges":[{"minimum":769.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX ORBIT FX PERIORBITAL","code_information":[{"code":"21386","type":"CPT"}],"standard_charges":[{"minimum":728.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX ORBIT FX COMBINED","code_information":[{"code":"21387","type":"CPT"}],"standard_charges":[{"minimum":803.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX ORBIT PERIORBTL IMPLT","code_information":[{"code":"21390","type":"CPT"}],"standard_charges":[{"minimum":845.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX ORBIT PERIORBT W/GRFT","code_information":[{"code":"21395","type":"CPT"}],"standard_charges":[{"minimum":1055.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"CLOSED TX ORBIT W/O MANIPULJ","code_information":[{"code":"21400","type":"CPT"}],"standard_charges":[{"minimum":180.95,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"CLOSED TX ORBIT W/MANIPULJ","code_information":[{"code":"21401","type":"CPT"}],"standard_charges":[{"minimum":349.75,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"OPN TX ORBIT FX W/O IMPLANT","code_information":[{"code":"21406","type":"CPT"}],"standard_charges":[{"minimum":615.46,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX ORBIT FX W/IMPLANT","code_information":[{"code":"21407","type":"CPT"}],"standard_charges":[{"minimum":676.61,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OPN TX ORBIT FX W/BONE GRFT","code_information":[{"code":"21408","type":"CPT"}],"standard_charges":[{"minimum":946.97,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21421","type":"CPT"}],"standard_charges":[{"minimum":572.9,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21422","type":"CPT"}],"standard_charges":[{"minimum":656.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21423","type":"CPT"}],"standard_charges":[{"minimum":836.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.11,"methodology":"fee schedule"}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21431","type":"CPT"}],"standard_charges":[{"minimum":728.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.11,"methodology":"fee schedule"}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21432","type":"CPT"}],"standard_charges":[{"minimum":747.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.78,"methodology":"fee schedule"}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21433","type":"CPT"}],"standard_charges":[{"minimum":1810.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1810.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1810.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1810.61,"methodology":"fee schedule"}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21435","type":"CPT"}],"standard_charges":[{"minimum":1474.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.1,"methodology":"fee schedule"}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21436","type":"CPT"}],"standard_charges":[{"minimum":2129.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2129.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2129.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2129.25,"methodology":"fee schedule"}]}]},{"description":"TREAT DENTAL RIDGE FRACTURE","code_information":[{"code":"21440","type":"CPT"}],"standard_charges":[{"minimum":637.27,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"TREAT DENTAL RIDGE FRACTURE","code_information":[{"code":"21445","type":"CPT"}],"standard_charges":[{"minimum":660.88,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21450","type":"CPT"}],"standard_charges":[{"minimum":504.6,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21451","type":"CPT"}],"standard_charges":[{"minimum":673.04,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21452","type":"CPT"}],"standard_charges":[{"minimum":480.28,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21453","type":"CPT"}],"standard_charges":[{"minimum":975.94,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21454","type":"CPT"}],"standard_charges":[{"minimum":516.4,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21461","type":"CPT"}],"standard_charges":[{"minimum":1115.77,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21462","type":"CPT"}],"standard_charges":[{"minimum":1216.97,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21465","type":"CPT"}],"standard_charges":[{"minimum":840.76,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21470","type":"CPT"}],"standard_charges":[{"minimum":1225.2,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RESET DISLOCATED JAW","code_information":[{"code":"21480","type":"CPT"}],"standard_charges":[{"minimum":32.54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"RESET DISLOCATED JAW","code_information":[{"code":"21485","type":"CPT"}],"standard_charges":[{"minimum":820.37,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REPAIR DISLOCATED JAW","code_information":[{"code":"21490","type":"CPT"}],"standard_charges":[{"minimum":828.6,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"INTERDENTAL WIRING","code_information":[{"code":"21497","type":"CPT"}],"standard_charges":[{"minimum":617.25,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"HEAD SURGERY PROCEDURE","code_information":[{"code":"21499","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAIN NECK/CHEST LESION","code_information":[{"code":"21501","type":"CPT"}],"standard_charges":[{"minimum":357.26,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DRAIN CHEST LESION","code_information":[{"code":"21502","type":"CPT"}],"standard_charges":[{"minimum":532.49,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF BONE LESION","code_information":[{"code":"21510","type":"CPT"}],"standard_charges":[{"minimum":475.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF NECK/CHEST","code_information":[{"code":"21550","type":"CPT"}],"standard_charges":[{"minimum":164.5,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC NECK LES SC 3 CM/>","code_information":[{"code":"21552","type":"CPT"}],"standard_charges":[{"minimum":472.05,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC NECK TUM DEEP 5 CM/>","code_information":[{"code":"21554","type":"CPT"}],"standard_charges":[{"minimum":770.31,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC NECK LES SC < 3 CM","code_information":[{"code":"21555","type":"CPT"}],"standard_charges":[{"minimum":325.79,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC NECK TUM DEEP < 5 CM","code_information":[{"code":"21556","type":"CPT"}],"standard_charges":[{"minimum":559.67,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT NECK THORAX TUMOR<5CM","code_information":[{"code":"21557","type":"CPT"}],"standard_charges":[{"minimum":1006.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT NECK TUMOR 5 CM/>","code_information":[{"code":"21558","type":"CPT"}],"standard_charges":[{"minimum":1402.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1402.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1402.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1402.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF RIB","code_information":[{"code":"21600","type":"CPT"}],"standard_charges":[{"minimum":598.29,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"EXC CHEST WALL TUMOR W/RIBS","code_information":[{"code":"21601","type":"CPT"}],"standard_charges":[{"minimum":1198.02,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC CH WAL TUM W/O LYMPHADEC","code_information":[{"code":"21602","type":"CPT"}],"standard_charges":[{"minimum":1596.76,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.76,"methodology":"fee schedule"}]}]},{"description":"EXC CH WAL TUM W/LYMPHADEC","code_information":[{"code":"21603","type":"CPT"}],"standard_charges":[{"minimum":1749.46,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1749.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1749.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1749.46,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF RIB","code_information":[{"code":"21610","type":"CPT"}],"standard_charges":[{"minimum":1270.97,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RIB","code_information":[{"code":"21615","type":"CPT"}],"standard_charges":[{"minimum":648.72,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.72,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RIB AND NERVES","code_information":[{"code":"21616","type":"CPT"}],"standard_charges":[{"minimum":740.98,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.98,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF STERNUM","code_information":[{"code":"21620","type":"CPT"}],"standard_charges":[{"minimum":527.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"}]}]},{"description":"STERNAL DEBRIDEMENT","code_information":[{"code":"21627","type":"CPT"}],"standard_charges":[{"minimum":575.76,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.76,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE STERNUM SURGERY","code_information":[{"code":"21630","type":"CPT"}],"standard_charges":[{"minimum":1376.47,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1376.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1376.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1376.47,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE STERNUM SURGERY","code_information":[{"code":"21632","type":"CPT"}],"standard_charges":[{"minimum":1261.32,"maximum":6060,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6060,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6060,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1261.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1261.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1261.32,"methodology":"fee schedule"}]}]},{"description":"HYOID MYOTOMY  SUSPENSION","code_information":[{"code":"21685","type":"CPT"}],"standard_charges":[{"minimum":1036.02,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1036.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1036.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1036.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NECK MUSCLE","code_information":[{"code":"21700","type":"CPT"}],"standard_charges":[{"minimum":369.42,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NECK MUSCLE/RIB","code_information":[{"code":"21705","type":"CPT"}],"standard_charges":[{"minimum":550.73,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NECK MUSCLE","code_information":[{"code":"21720","type":"CPT"}],"standard_charges":[{"minimum":565.03,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NECK MUSCLE","code_information":[{"code":"21725","type":"CPT"}],"standard_charges":[{"minimum":576.84,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF STERNUM","code_information":[{"code":"21740","type":"CPT"}],"standard_charges":[{"minimum":1063.55,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1063.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1063.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1063.55,"methodology":"fee schedule"}]}]},{"description":"REPAIR STERN/NUSS W/O SCOPE","code_information":[{"code":"21742","type":"CPT"}],"standard_charges":[{"minimum":1173.43,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR STERNUM/NUSS W/SCOPE","code_information":[{"code":"21743","type":"CPT"}],"standard_charges":[{"minimum":2103.34,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF STERNUM SEPARATION","code_information":[{"code":"21750","type":"CPT"}],"standard_charges":[{"minimum":702.36,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"}]}]},{"description":"OPTX OF RIB FX W/FIXJ SCOPE","code_information":[{"code":"21811","type":"CPT"}],"standard_charges":[{"minimum":614.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF RIB FRACTURE","code_information":[{"code":"21812","type":"CPT"}],"standard_charges":[{"minimum":741.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF RIB FRACTURE","code_information":[{"code":"21813","type":"CPT"}],"standard_charges":[{"minimum":1014.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT STERNUM FRACTURE","code_information":[{"code":"21820","type":"CPT"}],"standard_charges":[{"minimum":160.57,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT STERNUM FRACTURE","code_information":[{"code":"21825","type":"CPT"}],"standard_charges":[{"minimum":580.77,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.77,"methodology":"fee schedule"}]}]},{"description":"NECK/CHEST SURGERY PROCEDURE","code_information":[{"code":"21899","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SOFT TISSUE OF BACK","code_information":[{"code":"21920","type":"CPT"}],"standard_charges":[{"minimum":163.43,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SOFT TISSUE OF BACK","code_information":[{"code":"21925","type":"CPT"}],"standard_charges":[{"minimum":401.6,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC BACK LES SC < 3 CM","code_information":[{"code":"21930","type":"CPT"}],"standard_charges":[{"minimum":386.94,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC BACK LES SC 3 CM/>","code_information":[{"code":"21931","type":"CPT"}],"standard_charges":[{"minimum":495.66,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC BACK TUM DEEP < 5 CM","code_information":[{"code":"21932","type":"CPT"}],"standard_charges":[{"minimum":698.07,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC BACK TUM DEEP 5 CM/>","code_information":[{"code":"21933","type":"CPT"}],"standard_charges":[{"minimum":775.67,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT BACK TUM < 5 CM","code_information":[{"code":"21935","type":"CPT"}],"standard_charges":[{"minimum":1071.06,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT BACK TUM 5 CM/>","code_information":[{"code":"21936","type":"CPT"}],"standard_charges":[{"minimum":1480.18,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"ID P-SPINE C/T/CERV-THOR","code_information":[{"code":"22010","type":"CPT"}],"standard_charges":[{"minimum":1024.57,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.57,"methodology":"fee schedule"}]}]},{"description":"ID ABSCESS P-SPINE L/S/LS","code_information":[{"code":"22015","type":"CPT"}],"standard_charges":[{"minimum":1000.97,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.97,"methodology":"fee schedule"}]}]},{"description":"REMOVE PART OF NECK VERTEBRA","code_information":[{"code":"22100","type":"CPT"}],"standard_charges":[{"minimum":1000.25,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE PART THORAX VERTEBRA","code_information":[{"code":"22101","type":"CPT"}],"standard_charges":[{"minimum":926.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":926.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":926.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":926.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE PART LUMBAR VERTEBRA","code_information":[{"code":"22102","type":"CPT"}],"standard_charges":[{"minimum":814.65,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":814.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":814.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":814.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE EXTRA SPINE SEGMENT","code_information":[{"code":"22103","type":"CPT"}],"standard_charges":[{"minimum":139.47,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"}]}]},{"description":"REMOVE PART OF NECK VERTEBRA","code_information":[{"code":"22110","type":"CPT"}],"standard_charges":[{"minimum":1117.91,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1117.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1117.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1117.91,"methodology":"fee schedule"}]}]},{"description":"REMOVE PART THORAX VERTEBRA","code_information":[{"code":"22112","type":"CPT"}],"standard_charges":[{"minimum":1200.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.88,"methodology":"fee schedule"}]}]},{"description":"REMOVE PART LUMBAR VERTEBRA","code_information":[{"code":"22114","type":"CPT"}],"standard_charges":[{"minimum":1200.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.88,"methodology":"fee schedule"}]}]},{"description":"REMOVE EXTRA SPINE SEGMENT","code_information":[{"code":"22116","type":"CPT"}],"standard_charges":[{"minimum":145.55,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"}]}]},{"description":"INCIS SPINE 3 COLUMN THORAC","code_information":[{"code":"22206","type":"CPT"}],"standard_charges":[{"minimum":2564.47,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2564.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2564.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2564.47,"methodology":"fee schedule"}]}]},{"description":"INCIS SPINE 3 COLUMN LUMBAR","code_information":[{"code":"22207","type":"CPT"}],"standard_charges":[{"minimum":2511.54,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2511.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2511.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2511.54,"methodology":"fee schedule"}]}]},{"description":"INCIS SPINE 3 COLUMN ADL SEG","code_information":[{"code":"22208","type":"CPT"}],"standard_charges":[{"minimum":609.38,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.38,"methodology":"fee schedule"}]}]},{"description":"INCIS 1 VERTEBRAL SEG CERV","code_information":[{"code":"22210","type":"CPT"}],"standard_charges":[{"minimum":1879.63,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1879.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1879.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1879.63,"methodology":"fee schedule"}]}]},{"description":"INCIS 1 VERTEBRAL SEG THORAC","code_information":[{"code":"22212","type":"CPT"}],"standard_charges":[{"minimum":1592.83,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"}]}]},{"description":"INCIS 1 VERTEBRAL SEG LUMBAR","code_information":[{"code":"22214","type":"CPT"}],"standard_charges":[{"minimum":1592.83,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"}]}]},{"description":"INCIS ADDL SPINE SEGMENT","code_information":[{"code":"22216","type":"CPT"}],"standard_charges":[{"minimum":374.78,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"}]}]},{"description":"INCIS W/DISCECTOMY CERVICAL","code_information":[{"code":"22220","type":"CPT"}],"standard_charges":[{"minimum":1702.26,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.26,"methodology":"fee schedule"}]}]},{"description":"INCIS W/DISCECTOMY THORACIC","code_information":[{"code":"22222","type":"CPT"}],"standard_charges":[{"minimum":1854.96,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1854.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1854.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1854.96,"methodology":"fee schedule"}]}]},{"description":"INCIS W/DISCECTOMY LUMBAR","code_information":[{"code":"22224","type":"CPT"}],"standard_charges":[{"minimum":1664.35,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1664.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1664.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1664.35,"methodology":"fee schedule"}]}]},{"description":"REVISE EXTRA SPINE SEGMENT","code_information":[{"code":"22226","type":"CPT"}],"standard_charges":[{"minimum":371.21,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.21,"methodology":"fee schedule"}]}]},{"description":"CLOSED TX VERT FX W/O MANJ","code_information":[{"code":"22310","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1605.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"CLOSED TX VERT FX W/MANJ","code_information":[{"code":"22315","type":"CPT"}],"standard_charges":[{"minimum":824.66,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT ODONTOID FX W/O GRAFT","code_information":[{"code":"22318","type":"CPT"}],"standard_charges":[{"minimum":1739.09,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1739.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1739.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1739.09,"methodology":"fee schedule"}]}]},{"description":"TREAT ODONTOID FX W/GRAFT","code_information":[{"code":"22319","type":"CPT"}],"standard_charges":[{"minimum":1926.13,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1926.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1926.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1926.13,"methodology":"fee schedule"}]}]},{"description":"TREAT SPINE FRACTURE","code_information":[{"code":"22325","type":"CPT"}],"standard_charges":[{"minimum":1555.63,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1555.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1555.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1555.63,"methodology":"fee schedule"}]}]},{"description":"TREAT NECK SPINE FRACTURE","code_information":[{"code":"22326","type":"CPT"}],"standard_charges":[{"minimum":1589.97,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.97,"methodology":"fee schedule"}]}]},{"description":"TREAT THORAX SPINE FRACTURE","code_information":[{"code":"22327","type":"CPT"}],"standard_charges":[{"minimum":1620.36,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1620.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1620.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1620.36,"methodology":"fee schedule"}]}]},{"description":"TREAT EACH ADD SPINE FX","code_information":[{"code":"22328","type":"CPT"}],"standard_charges":[{"minimum":291.1,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.1,"methodology":"fee schedule"}]}]},{"description":"MANIPULATION OF SPINE","code_information":[{"code":"22505","type":"CPT"}],"standard_charges":[{"minimum":136.97,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"PERQ CERVICOTHORACIC INJECT","code_information":[{"code":"22510","type":"CPT"}],"standard_charges":[{"minimum":449.52,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PERQ LUMBOSACRAL INJECTION","code_information":[{"code":"22511","type":"CPT"}],"standard_charges":[{"minimum":423.06,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"VERTEBROPLASTY ADDL INJECT","code_information":[{"code":"22512","type":"CPT"}],"standard_charges":[{"minimum":214.21,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"}]}]},{"description":"PERQ VERTEBRAL AUGMENTATION","code_information":[{"code":"22513","type":"CPT"}],"standard_charges":[{"minimum":531.06,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PERQ VERTEBRAL AUGMENTATION","code_information":[{"code":"22514","type":"CPT"}],"standard_charges":[{"minimum":494.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PERQ VERTEBRAL AUGMENTATION","code_information":[{"code":"22515","type":"CPT"}],"standard_charges":[{"minimum":224.94,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"}]}]},{"description":"LAT THORAX SPINE FUSION","code_information":[{"code":"22532","type":"CPT"}],"standard_charges":[{"minimum":1880.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1880.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1880.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1880.71,"methodology":"fee schedule"}]}]},{"description":"LAT LUMBAR SPINE FUSION","code_information":[{"code":"22533","type":"CPT"}],"standard_charges":[{"minimum":1743.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1743.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1743.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1743.38,"methodology":"fee schedule"}]}]},{"description":"LAT THOR/LUMB ADDL SEG","code_information":[{"code":"22534","type":"CPT"}],"standard_charges":[{"minimum":372.99,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.99,"methodology":"fee schedule"}]}]},{"description":"NECK SPINE FUSION","code_information":[{"code":"22548","type":"CPT"}],"standard_charges":[{"minimum":2064.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2064.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2064.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2064.88,"methodology":"fee schedule"}]}]},{"description":"NECK SPINE FUSEREMOV BEL C2","code_information":[{"code":"22551","type":"CPT"}],"standard_charges":[{"minimum":1782.01,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1782.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1782.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1782.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"ADDL NECK SPINE FUSION","code_information":[{"code":"22552","type":"CPT"}],"standard_charges":[{"minimum":409.83,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.83,"methodology":"fee schedule"}]}]},{"description":"NECK SPINE FUSION","code_information":[{"code":"22554","type":"CPT"}],"standard_charges":[{"minimum":1327.12,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1327.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1327.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1327.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"THORAX SPINE FUSION","code_information":[{"code":"22556","type":"CPT"}],"standard_charges":[{"minimum":1768.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1768.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1768.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1768.06,"methodology":"fee schedule"}]}]},{"description":"LUMBAR SPINE FUSION","code_information":[{"code":"22558","type":"CPT"}],"standard_charges":[{"minimum":1598.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1598.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1598.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1598.55,"methodology":"fee schedule"}]}]},{"description":"ADDITIONAL SPINAL FUSION","code_information":[{"code":"22585","type":"CPT"}],"standard_charges":[{"minimum":335.8,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.8,"methodology":"fee schedule"}]}]},{"description":"SPINE  SKULL SPINAL FUSION","code_information":[{"code":"22590","type":"CPT"}],"standard_charges":[{"minimum":1672.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1672.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1672.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1672.93,"methodology":"fee schedule"}]}]},{"description":"NECK SPINAL FUSION","code_information":[{"code":"22595","type":"CPT"}],"standard_charges":[{"minimum":1599.62,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1599.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1599.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1599.62,"methodology":"fee schedule"}]}]},{"description":"NECK SPINE FUSION","code_information":[{"code":"22600","type":"CPT"}],"standard_charges":[{"minimum":1373.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1373.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1373.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1373.25,"methodology":"fee schedule"}]}]},{"description":"THORAX SPINE FUSION","code_information":[{"code":"22610","type":"CPT"}],"standard_charges":[{"minimum":1350.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.36,"methodology":"fee schedule"}]}]},{"description":"LUMBAR SPINE FUSION","code_information":[{"code":"22612","type":"CPT"}],"standard_charges":[{"minimum":1658.27,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1658.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1658.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1658.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22614","type":"CPT"}],"standard_charges":[{"minimum":404.82,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.82,"methodology":"fee schedule"}]}]},{"description":"LUMBAR SPINE FUSION","code_information":[{"code":"22630","type":"CPT"}],"standard_charges":[{"minimum":1637.89,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1637.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1637.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1637.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22632","type":"CPT"}],"standard_charges":[{"minimum":332.23,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"}]}]},{"description":"LUMBAR SPINE FUSION COMBINED","code_information":[{"code":"22633","type":"CPT"}],"standard_charges":[{"minimum":1894.3,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22634","type":"CPT"}],"standard_charges":[{"minimum":501.02,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.02,"methodology":"fee schedule"}]}]},{"description":"POST FUSION </6 VERT SEG","code_information":[{"code":"22800","type":"CPT"}],"standard_charges":[{"minimum":1436.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1436.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1436.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1436.91,"methodology":"fee schedule"}]}]},{"description":"POST FUSION 7-12 VERT SEG","code_information":[{"code":"22802","type":"CPT"}],"standard_charges":[{"minimum":2217.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.94,"methodology":"fee schedule"}]}]},{"description":"POST FUSION 13/> VERT SEG","code_information":[{"code":"22804","type":"CPT"}],"standard_charges":[{"minimum":2544.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2544.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2544.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2544.44,"methodology":"fee schedule"}]}]},{"description":"ANT FUSION 2-3 VERT SEG","code_information":[{"code":"22808","type":"CPT"}],"standard_charges":[{"minimum":1915.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1915.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1915.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1915.75,"methodology":"fee schedule"}]}]},{"description":"ANT FUSION 4-7 VERT SEG","code_information":[{"code":"22810","type":"CPT"}],"standard_charges":[{"minimum":2099.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2099.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2099.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2099.93,"methodology":"fee schedule"}]}]},{"description":"ANT FUSION 8/> VERT SEG","code_information":[{"code":"22812","type":"CPT"}],"standard_charges":[{"minimum":2301.62,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2301.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2301.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2301.62,"methodology":"fee schedule"}]}]},{"description":"KYPHECTOMY 1-2 SEGMENTS","code_information":[{"code":"22818","type":"CPT"}],"standard_charges":[{"minimum":2245.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2245.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2245.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2245.83,"methodology":"fee schedule"}]}]},{"description":"KYPHECTOMY 3 OR MORE","code_information":[{"code":"22819","type":"CPT"}],"standard_charges":[{"minimum":2585.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2585.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2585.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2585.21,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF SPINAL FUSION","code_information":[{"code":"22830","type":"CPT"}],"standard_charges":[{"minimum":867.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.94,"methodology":"fee schedule"}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22840","type":"CPT"}],"standard_charges":[{"minimum":782.47,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.47,"methodology":"fee schedule"}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22841","type":"CPT"}],"standard_charges":[{"minimum":1488,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"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":789.26,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22843","type":"CPT"}],"standard_charges":[{"minimum":845.05,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22844","type":"CPT"}],"standard_charges":[{"minimum":1017.78,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.78,"methodology":"fee schedule"}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22845","type":"CPT"}],"standard_charges":[{"minimum":751.35,"maximum":9595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22846","type":"CPT"}],"standard_charges":[{"minimum":781.75,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22847","type":"CPT"}],"standard_charges":[{"minimum":827.53,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.53,"methodology":"fee schedule"}]}]},{"description":"INSERT PELV FIXATION DEVICE","code_information":[{"code":"22848","type":"CPT"}],"standard_charges":[{"minimum":372.28,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.28,"methodology":"fee schedule"}]}]},{"description":"REINSERT SPINAL FIXATION","code_information":[{"code":"22849","type":"CPT"}],"standard_charges":[{"minimum":1370.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.39,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE FIXATION DEVICE","code_information":[{"code":"22850","type":"CPT"}],"standard_charges":[{"minimum":776.39,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.39,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE FIXATION DEVICE","code_information":[{"code":"22852","type":"CPT"}],"standard_charges":[{"minimum":748.49,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"}]}]},{"description":"INSJ BIOMECHANICAL DEVICE","code_information":[{"code":"22853","type":"CPT"}],"standard_charges":[{"minimum":266.42,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.42,"methodology":"fee schedule"}]}]},{"description":"INSJ BIOMECHANICAL DEVICE","code_information":[{"code":"22854","type":"CPT"}],"standard_charges":[{"minimum":346.89,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE FIXATION DEVICE","code_information":[{"code":"22855","type":"CPT"}],"standard_charges":[{"minimum":1165.12,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.12,"methodology":"fee schedule"}]}]},{"description":"CERV ARTIFIC DISKECTOMY","code_information":[{"code":"22856","type":"CPT"}],"standard_charges":[{"minimum":1701.54,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"LUMBAR ARTIF DISKECTOMY","code_information":[{"code":"22857","type":"CPT"}],"standard_charges":[{"minimum":1827.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1827.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1827.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1827.78,"methodology":"fee schedule"}]}]},{"description":"SECOND LEVEL CER DISKECTOMY","code_information":[{"code":"22858","type":"CPT"}],"standard_charges":[{"minimum":523.19,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.19,"methodology":"fee schedule"}]}]},{"description":"INSJ BIOMECHANICAL DEVICE","code_information":[{"code":"22859","type":"CPT"}],"standard_charges":[{"minimum":344.74,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"}]}]},{"description":"REVISE CERV ARTIFIC DISC","code_information":[{"code":"22861","type":"CPT"}],"standard_charges":[{"minimum":2427.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427.5,"methodology":"fee schedule"}]}]},{"description":"REVISE LUMBAR ARTIF DISC","code_information":[{"code":"22862","type":"CPT"}],"standard_charges":[{"minimum":2430.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2430.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2430.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2430.01,"methodology":"fee schedule"}]}]},{"description":"REMOVE CERV ARTIF DISC","code_information":[{"code":"22864","type":"CPT"}],"standard_charges":[{"minimum":2169.3,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2169.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2169.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2169.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE LUMB ARTIF DISC","code_information":[{"code":"22865","type":"CPT"}],"standard_charges":[{"minimum":2371.72,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2371.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2371.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2371.72,"methodology":"fee schedule"}]}]},{"description":"INSJ STABLJ DEV W/DCMPRN","code_information":[{"code":"22867","type":"CPT"}],"standard_charges":[{"minimum":1125.06,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"INSJ STABLJ DEV W/DCMPRN","code_information":[{"code":"22868","type":"CPT"}],"standard_charges":[{"minimum":250.69,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"}]}]},{"description":"INSJ STABLJ DEV W/O DCMPRN","code_information":[{"code":"22869","type":"CPT"}],"standard_charges":[{"minimum":457.03,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"INSJ STABLJ DEV W/O DCMPRN","code_information":[{"code":"22870","type":"CPT"}],"standard_charges":[{"minimum":122.66,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"}]}]},{"description":"SPINE SURGERY PROCEDURE","code_information":[{"code":"22899","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"EXC ABDL TUM DEEP < 5 CM","code_information":[{"code":"22900","type":"CPT"}],"standard_charges":[{"minimum":596.86,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC ABDL TUM DEEP 5 CM/>","code_information":[{"code":"22901","type":"CPT"}],"standard_charges":[{"minimum":701.29,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC ABD LES SC < 3 CM","code_information":[{"code":"22902","type":"CPT"}],"standard_charges":[{"minimum":353.68,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC ABD LES SC 3 CM/>","code_information":[{"code":"22903","type":"CPT"}],"standard_charges":[{"minimum":464.54,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RADICAL RESECT ABD TUMOR<5CM","code_information":[{"code":"22904","type":"CPT"}],"standard_charges":[{"minimum":1098.6,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RAD RESECT ABD TUMOR 5 CM/>","code_information":[{"code":"22905","type":"CPT"}],"standard_charges":[{"minimum":1390.77,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1390.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1390.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1390.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"ABDOMEN SURGERY PROCEDURE","code_information":[{"code":"22999","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF CALCIUM DEPOSITS","code_information":[{"code":"23000","type":"CPT"}],"standard_charges":[{"minimum":381.93,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RELEASE SHOULDER JOINT","code_information":[{"code":"23020","type":"CPT"}],"standard_charges":[{"minimum":732.4,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DRAIN SHOULDER LESION","code_information":[{"code":"23030","type":"CPT"}],"standard_charges":[{"minimum":269.64,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DRAIN SHOULDER BURSA","code_information":[{"code":"23031","type":"CPT"}],"standard_charges":[{"minimum":236.03,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DRAIN SHOULDER BONE LESION","code_information":[{"code":"23035","type":"CPT"}],"standard_charges":[{"minimum":718.81,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"EXPLORATORY SHOULDER SURGERY","code_information":[{"code":"23040","type":"CPT"}],"standard_charges":[{"minimum":760.65,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORATORY SHOULDER SURGERY","code_information":[{"code":"23044","type":"CPT"}],"standard_charges":[{"minimum":600.8,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SHOULDER TISSUES","code_information":[{"code":"23065","type":"CPT"}],"standard_charges":[{"minimum":168.8,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SHOULDER TISSUES","code_information":[{"code":"23066","type":"CPT"}],"standard_charges":[{"minimum":393.38,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC SHOULDER LES SC 3 CM/>","code_information":[{"code":"23071","type":"CPT"}],"standard_charges":[{"minimum":444.16,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC SHOULDER TUM DEEP 5 CM/>","code_information":[{"code":"23073","type":"CPT"}],"standard_charges":[{"minimum":734.9,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC SHOULDER LES SC < 3 CM","code_information":[{"code":"23075","type":"CPT"}],"standard_charges":[{"minimum":349.75,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC SHOULDER TUM DEEP < 5 CM","code_information":[{"code":"23076","type":"CPT"}],"standard_charges":[{"minimum":575.05,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT SHOULDER TUMOR < 5 CM","code_information":[{"code":"23077","type":"CPT"}],"standard_charges":[{"minimum":1184.79,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT SHOULDER TUMOR 5 CM/>","code_information":[{"code":"23078","type":"CPT"}],"standard_charges":[{"minimum":1503.42,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1503.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1503.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1503.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF SHOULDER JOINT","code_information":[{"code":"23100","type":"CPT"}],"standard_charges":[{"minimum":541.43,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHOULDER JOINT SURGERY","code_information":[{"code":"23101","type":"CPT"}],"standard_charges":[{"minimum":489.94,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE SHOULDER JOINT LINING","code_information":[{"code":"23105","type":"CPT"}],"standard_charges":[{"minimum":682.33,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF COLLARBONE JOINT","code_information":[{"code":"23106","type":"CPT"}],"standard_charges":[{"minimum":537.5,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORE TREAT SHOULDER JOINT","code_information":[{"code":"23107","type":"CPT"}],"standard_charges":[{"minimum":707.01,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL COLLAR BONE","code_information":[{"code":"23120","type":"CPT"}],"standard_charges":[{"minimum":627.62,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF COLLAR BONE","code_information":[{"code":"23125","type":"CPT"}],"standard_charges":[{"minimum":754.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE SHOULDER BONE PART","code_information":[{"code":"23130","type":"CPT"}],"standard_charges":[{"minimum":658.73,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23140","type":"CPT"}],"standard_charges":[{"minimum":592.57,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":592.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":592.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":592.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23145","type":"CPT"}],"standard_charges":[{"minimum":739.19,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23146","type":"CPT"}],"standard_charges":[{"minimum":664.81,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23150","type":"CPT"}],"standard_charges":[{"minimum":709.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23155","type":"CPT"}],"standard_charges":[{"minimum":845.76,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23156","type":"CPT"}],"standard_charges":[{"minimum":721.67,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE COLLAR BONE LESION","code_information":[{"code":"23170","type":"CPT"}],"standard_charges":[{"minimum":602.94,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE SHOULDER BLADE LESION","code_information":[{"code":"23172","type":"CPT"}],"standard_charges":[{"minimum":608.66,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"23174","type":"CPT"}],"standard_charges":[{"minimum":812.51,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE COLLAR BONE LESION","code_information":[{"code":"23180","type":"CPT"}],"standard_charges":[{"minimum":701.29,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SHOULDER BLADE LESION","code_information":[{"code":"23182","type":"CPT"}],"standard_charges":[{"minimum":715.23,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"23184","type":"CPT"}],"standard_charges":[{"minimum":787.12,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF SCAPULA","code_information":[{"code":"23190","type":"CPT"}],"standard_charges":[{"minimum":613.31,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HEAD OF HUMERUS","code_information":[{"code":"23195","type":"CPT"}],"standard_charges":[{"minimum":792.84,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RESECT CLAVICLE TUMOR","code_information":[{"code":"23200","type":"CPT"}],"standard_charges":[{"minimum":1577.81,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1577.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1577.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1577.81,"methodology":"fee schedule"}]}]},{"description":"RESECT SCAPULA TUMOR","code_information":[{"code":"23210","type":"CPT"}],"standard_charges":[{"minimum":1848.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"}]}]},{"description":"RESECT PROX HUMERUS TUMOR","code_information":[{"code":"23220","type":"CPT"}],"standard_charges":[{"minimum":2023.4,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2023.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2023.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2023.4,"methodology":"fee schedule"}]}]},{"description":"REMOVE SHOULDER FOREIGN BODY","code_information":[{"code":"23330","type":"CPT"}],"standard_charges":[{"minimum":178.09,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVE SHOULDER FB DEEP","code_information":[{"code":"23333","type":"CPT"}],"standard_charges":[{"minimum":505.31,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"SHOULDER PROSTHESIS REMOVAL","code_information":[{"code":"23334","type":"CPT"}],"standard_charges":[{"minimum":1115.77,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"SHOULDER PROSTHESIS REMOVAL","code_information":[{"code":"23335","type":"CPT"}],"standard_charges":[{"minimum":1331.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.77,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR SHOULDER X-RAY","code_information":[{"code":"23350","type":"CPT"}],"standard_charges":[{"minimum":51.85,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":284.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":284.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"}]}]},{"description":"MUSCLE TRANSFER SHOULDER/ARM","code_information":[{"code":"23395","type":"CPT"}],"standard_charges":[{"minimum":1351.79,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"MUSCLE TRANSFERS","code_information":[{"code":"23397","type":"CPT"}],"standard_charges":[{"minimum":1201.24,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1201.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1201.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1201.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FIXATION OF SHOULDER BLADE","code_information":[{"code":"23400","type":"CPT"}],"standard_charges":[{"minimum":1026.72,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TENDON  MUSCLE","code_information":[{"code":"23405","type":"CPT"}],"standard_charges":[{"minimum":653.37,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISE TENDON(S)  MUSCLE(S)","code_information":[{"code":"23406","type":"CPT"}],"standard_charges":[{"minimum":774.24,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR ROTATOR CUFF ACUTE","code_information":[{"code":"23410","type":"CPT"}],"standard_charges":[{"minimum":867.22,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR ROTATOR CUFF CHRONIC","code_information":[{"code":"23412","type":"CPT"}],"standard_charges":[{"minimum":901.19,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF SHOULDER LIGAMENT","code_information":[{"code":"23415","type":"CPT"}],"standard_charges":[{"minimum":741.34,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SHOULDER","code_information":[{"code":"23420","type":"CPT"}],"standard_charges":[{"minimum":1029.94,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR BICEPS TENDON","code_information":[{"code":"23430","type":"CPT"}],"standard_charges":[{"minimum":789.62,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE/TRANSPLANT TENDON","code_information":[{"code":"23440","type":"CPT"}],"standard_charges":[{"minimum":802.49,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23450","type":"CPT"}],"standard_charges":[{"minimum":997.75,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":997.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":997.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":997.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23455","type":"CPT"}],"standard_charges":[{"minimum":1039.59,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23460","type":"CPT"}],"standard_charges":[{"minimum":1149.02,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23462","type":"CPT"}],"standard_charges":[{"minimum":1123.99,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23465","type":"CPT"}],"standard_charges":[{"minimum":1177.99,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23466","type":"CPT"}],"standard_charges":[{"minimum":1184.79,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT SHOULDER JOINT","code_information":[{"code":"23470","type":"CPT"}],"standard_charges":[{"minimum":1259.53,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT SHOULDER JOINT","code_information":[{"code":"23472","type":"CPT"}],"standard_charges":[{"minimum":1515.22,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8619.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6465.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6465.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1515.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1515.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1515.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"REVIS RECONST SHOULDER JOINT","code_information":[{"code":"23473","type":"CPT"}],"standard_charges":[{"minimum":1684.73,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1684.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1684.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1684.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVIS RECONST SHOULDER JOINT","code_information":[{"code":"23474","type":"CPT"}],"standard_charges":[{"minimum":1818.48,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1818.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1818.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1818.48,"methodology":"fee schedule"}]}]},{"description":"REVISION OF COLLAR BONE","code_information":[{"code":"23480","type":"CPT"}],"standard_charges":[{"minimum":867.94,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF COLLAR BONE","code_information":[{"code":"23485","type":"CPT"}],"standard_charges":[{"minimum":1006.33,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REINFORCE CLAVICLE","code_information":[{"code":"23490","type":"CPT"}],"standard_charges":[{"minimum":910.14,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":910.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":910.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":910.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REINFORCE SHOULDER BONES","code_information":[{"code":"23491","type":"CPT"}],"standard_charges":[{"minimum":1071.42,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE FRACTURE","code_information":[{"code":"23500","type":"CPT"}],"standard_charges":[{"minimum":250.33,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE FRACTURE","code_information":[{"code":"23505","type":"CPT"}],"standard_charges":[{"minimum":363.7,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE FRACTURE","code_information":[{"code":"23515","type":"CPT"}],"standard_charges":[{"minimum":764.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23520","type":"CPT"}],"standard_charges":[{"minimum":261.42,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1605.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23525","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23530","type":"CPT"}],"standard_charges":[{"minimum":613.67,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23532","type":"CPT"}],"standard_charges":[{"minimum":667.31,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23540","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23545","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23550","type":"CPT"}],"standard_charges":[{"minimum":609.38,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23552","type":"CPT"}],"standard_charges":[{"minimum":690.56,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT SHOULDER BLADE FX","code_information":[{"code":"23570","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT SHOULDER BLADE FX","code_information":[{"code":"23575","type":"CPT"}],"standard_charges":[{"minimum":411.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT SCAPULA FRACTURE","code_information":[{"code":"23585","type":"CPT"}],"standard_charges":[{"minimum":1029.22,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23600","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23605","type":"CPT"}],"standard_charges":[{"minimum":462.4,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23615","type":"CPT"}],"standard_charges":[{"minimum":934.45,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23616","type":"CPT"}],"standard_charges":[{"minimum":1300.3,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1300.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1300.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1300.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23620","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23625","type":"CPT"}],"standard_charges":[{"minimum":383.72,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23630","type":"CPT"}],"standard_charges":[{"minimum":828.6,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT SHOULDER DISLOCATION","code_information":[{"code":"23650","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT SHOULDER DISLOCATION","code_information":[{"code":"23655","type":"CPT"}],"standard_charges":[{"minimum":439.51,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT SHOULDER DISLOCATION","code_information":[{"code":"23660","type":"CPT"}],"standard_charges":[{"minimum":623.68,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT DISLOCATION/FRACTURE","code_information":[{"code":"23665","type":"CPT"}],"standard_charges":[{"minimum":434.5,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT DISLOCATION/FRACTURE","code_information":[{"code":"23670","type":"CPT"}],"standard_charges":[{"minimum":923.01,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT DISLOCATION/FRACTURE","code_information":[{"code":"23675","type":"CPT"}],"standard_charges":[{"minimum":541.07,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT DISLOCATION/FRACTURE","code_information":[{"code":"23680","type":"CPT"}],"standard_charges":[{"minimum":973.43,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":973.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":973.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":973.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"FIXATION OF SHOULDER","code_information":[{"code":"23700","type":"CPT"}],"standard_charges":[{"minimum":207.78,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"FUSION OF SHOULDER JOINT","code_information":[{"code":"23800","type":"CPT"}],"standard_charges":[{"minimum":1083.22,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF SHOULDER JOINT","code_information":[{"code":"23802","type":"CPT"}],"standard_charges":[{"minimum":1351.08,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF ARM  GIRDLE","code_information":[{"code":"23900","type":"CPT"}],"standard_charges":[{"minimum":1453.71,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1453.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1453.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1453.71,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION AT SHOULDER JOINT","code_information":[{"code":"23920","type":"CPT"}],"standard_charges":[{"minimum":1183.35,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.35,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"23921","type":"CPT"}],"standard_charges":[{"minimum":504.6,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"SHOULDER SURGERY PROCEDURE","code_information":[{"code":"23929","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF ARM LESION","code_information":[{"code":"23930","type":"CPT"}],"standard_charges":[{"minimum":227.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF ARM BURSA","code_information":[{"code":"23931","type":"CPT"}],"standard_charges":[{"minimum":171.66,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DRAIN ARM/ELBOW BONE LESION","code_information":[{"code":"23935","type":"CPT"}],"standard_charges":[{"minimum":548.94,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORATORY ELBOW SURGERY","code_information":[{"code":"24000","type":"CPT"}],"standard_charges":[{"minimum":511.75,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE ELBOW JOINT","code_information":[{"code":"24006","type":"CPT"}],"standard_charges":[{"minimum":758.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY ARM/ELBOW SOFT TISSUE","code_information":[{"code":"24065","type":"CPT"}],"standard_charges":[{"minimum":172.37,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY ARM/ELBOW SOFT TISSUE","code_information":[{"code":"24066","type":"CPT"}],"standard_charges":[{"minimum":449.88,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC ARM/ELBOW LES SC 3 CM/>","code_information":[{"code":"24071","type":"CPT"}],"standard_charges":[{"minimum":429.14,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EX ARM/ELBOW TUM DEEP 5 CM/>","code_information":[{"code":"24073","type":"CPT"}],"standard_charges":[{"minimum":730.97,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC ARM/ELBOW LES SC < 3 CM","code_information":[{"code":"24075","type":"CPT"}],"standard_charges":[{"minimum":350.46,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EX ARM/ELBOW TUM DEEP < 5 CM","code_information":[{"code":"24076","type":"CPT"}],"standard_charges":[{"minimum":580.05,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT ARM/ELBOW TUM < 5 CM","code_information":[{"code":"24077","type":"CPT"}],"standard_charges":[{"minimum":1078.93,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT ARM/ELBOW TUM 5 CM/>","code_information":[{"code":"24079","type":"CPT"}],"standard_charges":[{"minimum":1388.98,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1388.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1388.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1388.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"BIOPSY ELBOW JOINT LINING","code_information":[{"code":"24100","type":"CPT"}],"standard_charges":[{"minimum":450.96,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT ELBOW JOINT","code_information":[{"code":"24101","type":"CPT"}],"standard_charges":[{"minimum":537.86,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELBOW JOINT LINING","code_information":[{"code":"24102","type":"CPT"}],"standard_charges":[{"minimum":657.3,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ELBOW BURSA","code_information":[{"code":"24105","type":"CPT"}],"standard_charges":[{"minimum":388.01,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"24110","type":"CPT"}],"standard_charges":[{"minimum":630.12,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24115","type":"CPT"}],"standard_charges":[{"minimum":782.82,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24116","type":"CPT"}],"standard_charges":[{"minimum":909.78,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELBOW LESION","code_information":[{"code":"24120","type":"CPT"}],"standard_charges":[{"minimum":568.97,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24125","type":"CPT"}],"standard_charges":[{"minimum":663.74,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24126","type":"CPT"}],"standard_charges":[{"minimum":692.35,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HEAD OF RADIUS","code_information":[{"code":"24130","type":"CPT"}],"standard_charges":[{"minimum":546.08,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARM BONE LESION","code_information":[{"code":"24134","type":"CPT"}],"standard_charges":[{"minimum":793.19,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE RADIUS BONE LESION","code_information":[{"code":"24136","type":"CPT"}],"standard_charges":[{"minimum":673.39,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELBOW BONE LESION","code_information":[{"code":"24138","type":"CPT"}],"standard_charges":[{"minimum":733.11,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ARM BONE","code_information":[{"code":"24140","type":"CPT"}],"standard_charges":[{"minimum":746.7,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"24145","type":"CPT"}],"standard_charges":[{"minimum":633.7,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":633.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":633.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":633.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ELBOW","code_information":[{"code":"24147","type":"CPT"}],"standard_charges":[{"minimum":669.46,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RADICAL RESECTION OF ELBOW","code_information":[{"code":"24149","type":"CPT"}],"standard_charges":[{"minimum":1248.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RESECT DISTAL HUMERUS TUMOR","code_information":[{"code":"24150","type":"CPT"}],"standard_charges":[{"minimum":1618.93,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RESECT RADIUS TUMOR","code_information":[{"code":"24152","type":"CPT"}],"standard_charges":[{"minimum":1410.8,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ELBOW JOINT","code_information":[{"code":"24155","type":"CPT"}],"standard_charges":[{"minimum":900.84,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELBOW JOINT IMPLANT","code_information":[{"code":"24160","type":"CPT"}],"standard_charges":[{"minimum":1320.68,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1320.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1320.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1320.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE RADIUS HEAD IMPLANT","code_information":[{"code":"24164","type":"CPT"}],"standard_charges":[{"minimum":768.88,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":768.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":768.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":768.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARM FOREIGN BODY","code_information":[{"code":"24200","type":"CPT"}],"standard_charges":[{"minimum":150.2,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARM FOREIGN BODY","code_information":[{"code":"24201","type":"CPT"}],"standard_charges":[{"minimum":427.71,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR ELBOW X-RAY","code_information":[{"code":"24220","type":"CPT"}],"standard_charges":[{"minimum":69.02,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"}]}]},{"description":"MANIPULATE ELBOW W/ANESTH","code_information":[{"code":"24300","type":"CPT"}],"standard_charges":[{"minimum":474.2,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"MUSCLE/TENDON TRANSFER","code_information":[{"code":"24301","type":"CPT"}],"standard_charges":[{"minimum":795.7,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"ARM TENDON LENGTHENING","code_information":[{"code":"24305","type":"CPT"}],"standard_charges":[{"minimum":618.32,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ARM TENDON","code_information":[{"code":"24310","type":"CPT"}],"standard_charges":[{"minimum":507.1,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ARM TENDON","code_information":[{"code":"24320","type":"CPT"}],"standard_charges":[{"minimum":826.81,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ARM MUSCLES","code_information":[{"code":"24330","type":"CPT"}],"standard_charges":[{"minimum":762.44,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ARM MUSCLES","code_information":[{"code":"24331","type":"CPT"}],"standard_charges":[{"minimum":832.17,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TENOLYSIS TRICEPS","code_information":[{"code":"24332","type":"CPT"}],"standard_charges":[{"minimum":656.58,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF BICEPS TENDON","code_information":[{"code":"24340","type":"CPT"}],"standard_charges":[{"minimum":636.56,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":636.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":636.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":636.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARM TENDON/MUSCLE","code_information":[{"code":"24341","type":"CPT"}],"standard_charges":[{"minimum":798.2,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF RUPTURED TENDON","code_information":[{"code":"24342","type":"CPT"}],"standard_charges":[{"minimum":820.37,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPR ELBOW LAT LIGMNT W/TISS","code_information":[{"code":"24343","type":"CPT"}],"standard_charges":[{"minimum":761.01,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":761.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":761.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":761.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ELBOW LAT LIGMNT","code_information":[{"code":"24344","type":"CPT"}],"standard_charges":[{"minimum":1167.62,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPR ELBW MED LIGMNT W/TISSU","code_information":[{"code":"24345","type":"CPT"}],"standard_charges":[{"minimum":757.43,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ELBOW MED LIGMNT","code_information":[{"code":"24346","type":"CPT"}],"standard_charges":[{"minimum":1167.62,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REPAIR ELBOW PERC","code_information":[{"code":"24357","type":"CPT"}],"standard_charges":[{"minimum":445.23,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR ELBOW W/DEB OPEN","code_information":[{"code":"24358","type":"CPT"}],"standard_charges":[{"minimum":566.11,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR ELBOW DEB/ATTCH OPEN","code_information":[{"code":"24359","type":"CPT"}],"standard_charges":[{"minimum":706.29,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24360","type":"CPT"}],"standard_charges":[{"minimum":954.84,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24361","type":"CPT"}],"standard_charges":[{"minimum":1062.84,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24362","type":"CPT"}],"standard_charges":[{"minimum":1118.27,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REPLACE ELBOW JOINT","code_information":[{"code":"24363","type":"CPT"}],"standard_charges":[{"minimum":1521.3,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1521.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1521.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1521.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT HEAD OF RADIUS","code_information":[{"code":"24365","type":"CPT"}],"standard_charges":[{"minimum":681.62,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT HEAD OF RADIUS","code_information":[{"code":"24366","type":"CPT"}],"standard_charges":[{"minimum":722.39,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISE RECONST ELBOW JOINT","code_information":[{"code":"24370","type":"CPT"}],"standard_charges":[{"minimum":1611.78,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1611.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1611.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1611.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISE RECONST ELBOW JOINT","code_information":[{"code":"24371","type":"CPT"}],"standard_charges":[{"minimum":1851.38,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1851.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1851.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1851.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24400","type":"CPT"}],"standard_charges":[{"minimum":876.52,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24410","type":"CPT"}],"standard_charges":[{"minimum":1116.12,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24420","type":"CPT"}],"standard_charges":[{"minimum":1123.27,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HUMERUS","code_information":[{"code":"24430","type":"CPT"}],"standard_charges":[{"minimum":1112.9,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REPAIR HUMERUS WITH GRAFT","code_information":[{"code":"24435","type":"CPT"}],"standard_charges":[{"minimum":1141.87,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ELBOW JOINT","code_information":[{"code":"24470","type":"CPT"}],"standard_charges":[{"minimum":715.23,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF FOREARM","code_information":[{"code":"24495","type":"CPT"}],"standard_charges":[{"minimum":972.36,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REINFORCE HUMERUS","code_information":[{"code":"24498","type":"CPT"}],"standard_charges":[{"minimum":916.93,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24500","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24505","type":"CPT"}],"standard_charges":[{"minimum":489.22,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24515","type":"CPT"}],"standard_charges":[{"minimum":931.95,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24516","type":"CPT"}],"standard_charges":[{"minimum":907.99,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":907.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":907.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":907.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24530","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24535","type":"CPT"}],"standard_charges":[{"minimum":616.53,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24538","type":"CPT"}],"standard_charges":[{"minimum":838.61,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24545","type":"CPT"}],"standard_charges":[{"minimum":981.3,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24546","type":"CPT"}],"standard_charges":[{"minimum":1094.31,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1094.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1094.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1094.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24560","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24565","type":"CPT"}],"standard_charges":[{"minimum":534.64,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24566","type":"CPT"}],"standard_charges":[{"minimum":767.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24575","type":"CPT"}],"standard_charges":[{"minimum":779.25,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24576","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24577","type":"CPT"}],"standard_charges":[{"minimum":548.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24579","type":"CPT"}],"standard_charges":[{"minimum":885.1,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24582","type":"CPT"}],"standard_charges":[{"minimum":869.37,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24586","type":"CPT"}],"standard_charges":[{"minimum":1145.09,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1145.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1145.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1145.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24587","type":"CPT"}],"standard_charges":[{"minimum":1147.24,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT ELBOW DISLOCATION","code_information":[{"code":"24600","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT ELBOW DISLOCATION","code_information":[{"code":"24605","type":"CPT"}],"standard_charges":[{"minimum":513.9,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT ELBOW DISLOCATION","code_information":[{"code":"24615","type":"CPT"}],"standard_charges":[{"minimum":757.43,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24620","type":"CPT"}],"standard_charges":[{"minimum":630.84,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24635","type":"CPT"}],"standard_charges":[{"minimum":718.81,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT ELBOW DISLOCATION","code_information":[{"code":"24640","type":"CPT"}],"standard_charges":[{"minimum":85.11,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24650","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24655","type":"CPT"}],"standard_charges":[{"minimum":441.3,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24665","type":"CPT"}],"standard_charges":[{"minimum":700.57,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":700.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":700.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":700.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24666","type":"CPT"}],"standard_charges":[{"minimum":777.46,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT ULNAR FRACTURE","code_information":[{"code":"24670","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT ULNAR FRACTURE","code_information":[{"code":"24675","type":"CPT"}],"standard_charges":[{"minimum":452.39,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT ULNAR FRACTURE","code_information":[{"code":"24685","type":"CPT"}],"standard_charges":[{"minimum":696.64,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF ELBOW JOINT","code_information":[{"code":"24800","type":"CPT"}],"standard_charges":[{"minimum":883.67,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":883.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":883.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":883.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION/GRAFT OF ELBOW JOINT","code_information":[{"code":"24802","type":"CPT"}],"standard_charges":[{"minimum":1057.47,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF UPPER ARM","code_information":[{"code":"24900","type":"CPT"}],"standard_charges":[{"minimum":783.18,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.18,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF UPPER ARM","code_information":[{"code":"24920","type":"CPT"}],"standard_charges":[{"minimum":777.1,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.1,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"24925","type":"CPT"}],"standard_charges":[{"minimum":607.23,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"24930","type":"CPT"}],"standard_charges":[{"minimum":818.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.94,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE UPPER ARM  IMPLANT","code_information":[{"code":"24931","type":"CPT"}],"standard_charges":[{"minimum":982.02,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.02,"methodology":"fee schedule"}]}]},{"description":"REVISION OF AMPUTATION","code_information":[{"code":"24935","type":"CPT"}],"standard_charges":[{"minimum":1287.78,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1287.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1287.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1287.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF UPPER ARM","code_information":[{"code":"24940","type":"CPT"}],"standard_charges":[{"minimum":1907.77,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1907.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1907.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1907.77,"methodology":"fee schedule"}]}]},{"description":"UPPER ARM/ELBOW SURGERY","code_information":[{"code":"24999","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TENDON SHEATH","code_information":[{"code":"25000","type":"CPT"}],"standard_charges":[{"minimum":372.64,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"INCISE FLEXOR CARPI RADIALIS","code_information":[{"code":"25001","type":"CPT"}],"standard_charges":[{"minimum":374.42,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS FOREARM 1 SPACE","code_information":[{"code":"25020","type":"CPT"}],"standard_charges":[{"minimum":781.75,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS FOREARM 1 SPACE","code_information":[{"code":"25023","type":"CPT"}],"standard_charges":[{"minimum":1379.69,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1379.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1379.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1379.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS FOREARM 2 SPACES","code_information":[{"code":"25024","type":"CPT"}],"standard_charges":[{"minimum":826.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS FOREARM 2 SPACES","code_information":[{"code":"25025","type":"CPT"}],"standard_charges":[{"minimum":1291.35,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1291.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1291.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1291.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF FOREARM LESION","code_information":[{"code":"25028","type":"CPT"}],"standard_charges":[{"minimum":732.4,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF FOREARM BURSA","code_information":[{"code":"25031","type":"CPT"}],"standard_charges":[{"minimum":395.88,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT FOREARM BONE LESION","code_information":[{"code":"25035","type":"CPT"}],"standard_charges":[{"minimum":628.69,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT WRIST JOINT","code_information":[{"code":"25040","type":"CPT"}],"standard_charges":[{"minimum":595.07,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY FOREARM SOFT TISSUES","code_information":[{"code":"25065","type":"CPT"}],"standard_charges":[{"minimum":167.36,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY FOREARM SOFT TISSUES","code_information":[{"code":"25066","type":"CPT"}],"standard_charges":[{"minimum":393.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC FOREARM LES SC 3 CM/>","code_information":[{"code":"25071","type":"CPT"}],"standard_charges":[{"minimum":449.88,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC FOREARM TUM DEEP 3 CM/>","code_information":[{"code":"25073","type":"CPT"}],"standard_charges":[{"minimum":569.33,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":569.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":569.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":569.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC FOREARM LES SC < 3 CM","code_information":[{"code":"25075","type":"CPT"}],"standard_charges":[{"minimum":336.52,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC FOREARM TUM DEEP < 3 CM","code_information":[{"code":"25076","type":"CPT"}],"standard_charges":[{"minimum":552.52,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"RESECT FOREARM/WRIST TUM<3CM","code_information":[{"code":"25077","type":"CPT"}],"standard_charges":[{"minimum":902.27,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT FORARM/WRIST TUM 3CM>","code_information":[{"code":"25078","type":"CPT"}],"standard_charges":[{"minimum":1224.48,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1224.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1224.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1224.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"INCISION OF WRIST CAPSULE","code_information":[{"code":"25085","type":"CPT"}],"standard_charges":[{"minimum":480.99,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF WRIST JOINT","code_information":[{"code":"25100","type":"CPT"}],"standard_charges":[{"minimum":376.21,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT WRIST JOINT","code_information":[{"code":"25101","type":"CPT"}],"standard_charges":[{"minimum":435.94,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE WRIST JOINT LINING","code_information":[{"code":"25105","type":"CPT"}],"standard_charges":[{"minimum":521.76,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE WRIST JOINT CARTILAGE","code_information":[{"code":"25107","type":"CPT"}],"standard_charges":[{"minimum":660.52,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXCISE TENDON FOREARM/WRIST","code_information":[{"code":"25109","type":"CPT"}],"standard_charges":[{"minimum":572.9,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE WRIST TENDON LESION","code_information":[{"code":"25110","type":"CPT"}],"standard_charges":[{"minimum":371.92,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE WRIST TENDON LESION","code_information":[{"code":"25111","type":"CPT"}],"standard_charges":[{"minimum":350.11,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REREMOVE WRIST TENDON LESION","code_information":[{"code":"25112","type":"CPT"}],"standard_charges":[{"minimum":420.2,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE WRIST/FOREARM LESION","code_information":[{"code":"25115","type":"CPT"}],"standard_charges":[{"minimum":805,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE WRIST/FOREARM LESION","code_information":[{"code":"25116","type":"CPT"}],"standard_charges":[{"minimum":645.86,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXCISE WRIST TENDON SHEATH","code_information":[{"code":"25118","type":"CPT"}],"standard_charges":[{"minimum":411.62,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25119","type":"CPT"}],"standard_charges":[{"minimum":537.5,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOREARM LESION","code_information":[{"code":"25120","type":"CPT"}],"standard_charges":[{"minimum":537.14,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT FOREARM LESION","code_information":[{"code":"25125","type":"CPT"}],"standard_charges":[{"minimum":635.49,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT FOREARM LESION","code_information":[{"code":"25126","type":"CPT"}],"standard_charges":[{"minimum":640.13,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":640.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":640.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":640.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF WRIST LESION","code_information":[{"code":"25130","type":"CPT"}],"standard_charges":[{"minimum":484.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE  GRAFT WRIST LESION","code_information":[{"code":"25135","type":"CPT"}],"standard_charges":[{"minimum":600.08,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE  GRAFT WRIST LESION","code_information":[{"code":"25136","type":"CPT"}],"standard_charges":[{"minimum":532.85,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREARM BONE LESION","code_information":[{"code":"25145","type":"CPT"}],"standard_charges":[{"minimum":557.52,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25150","type":"CPT"}],"standard_charges":[{"minimum":604.73,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"25151","type":"CPT"}],"standard_charges":[{"minimum":623.33,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT RADIUS/ULNAR TUMOR","code_information":[{"code":"25170","type":"CPT"}],"standard_charges":[{"minimum":1539.18,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1539.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1539.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1539.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF WRIST BONE","code_information":[{"code":"25210","type":"CPT"}],"standard_charges":[{"minimum":528.2,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF WRIST BONES","code_information":[{"code":"25215","type":"CPT"}],"standard_charges":[{"minimum":660.52,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"25230","type":"CPT"}],"standard_charges":[{"minimum":464.54,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25240","type":"CPT"}],"standard_charges":[{"minimum":461.68,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR WRIST X-RAY","code_information":[{"code":"25246","type":"CPT"}],"standard_charges":[{"minimum":75.81,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREARM FOREIGN BODY","code_information":[{"code":"25248","type":"CPT"}],"standard_charges":[{"minimum":453.82,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF WRIST PROSTHESIS","code_information":[{"code":"25250","type":"CPT"}],"standard_charges":[{"minimum":570.4,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF WRIST PROSTHESIS","code_information":[{"code":"25251","type":"CPT"}],"standard_charges":[{"minimum":764.23,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"MANIPULATE WRIST W/ANESTHES","code_information":[{"code":"25259","type":"CPT"}],"standard_charges":[{"minimum":466.33,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25260","type":"CPT"}],"standard_charges":[{"minimum":676.97,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25263","type":"CPT"}],"standard_charges":[{"minimum":676.61,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25265","type":"CPT"}],"standard_charges":[{"minimum":800.7,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25270","type":"CPT"}],"standard_charges":[{"minimum":528.92,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25272","type":"CPT"}],"standard_charges":[{"minimum":597.94,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25274","type":"CPT"}],"standard_charges":[{"minimum":707.72,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOREARM TENDON SHEATH","code_information":[{"code":"25275","type":"CPT"}],"standard_charges":[{"minimum":715.59,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE WRIST/FOREARM TENDON","code_information":[{"code":"25280","type":"CPT"}],"standard_charges":[{"minimum":604.37,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISE WRIST/FOREARM TENDON","code_information":[{"code":"25290","type":"CPT"}],"standard_charges":[{"minimum":467.76,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE WRIST/FOREARM TENDON","code_information":[{"code":"25295","type":"CPT"}],"standard_charges":[{"minimum":563.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":563.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":563.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":563.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF TENDONS AT WRIST","code_information":[{"code":"25300","type":"CPT"}],"standard_charges":[{"minimum":734.55,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF TENDONS AT WRIST","code_information":[{"code":"25301","type":"CPT"}],"standard_charges":[{"minimum":685.91,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":685.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":685.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":685.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT FOREARM TENDON","code_information":[{"code":"25310","type":"CPT"}],"standard_charges":[{"minimum":662.66,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":662.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":662.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":662.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT FOREARM TENDON","code_information":[{"code":"25312","type":"CPT"}],"standard_charges":[{"minimum":762.08,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE PALSY HAND TENDON(S)","code_information":[{"code":"25315","type":"CPT"}],"standard_charges":[{"minimum":816.08,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE PALSY HAND TENDON(S)","code_information":[{"code":"25316","type":"CPT"}],"standard_charges":[{"minimum":968.78,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/REVISE WRIST JOINT","code_information":[{"code":"25320","type":"CPT"}],"standard_charges":[{"minimum":1051.39,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE WRIST JOINT","code_information":[{"code":"25332","type":"CPT"}],"standard_charges":[{"minimum":895.83,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REALIGNMENT OF HAND","code_information":[{"code":"25335","type":"CPT"}],"standard_charges":[{"minimum":997.75,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":997.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":997.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":997.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ULNA/RADIOULNAR","code_information":[{"code":"25337","type":"CPT"}],"standard_charges":[{"minimum":943.04,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF RADIUS","code_information":[{"code":"25350","type":"CPT"}],"standard_charges":[{"minimum":717.74,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF RADIUS","code_information":[{"code":"25355","type":"CPT"}],"standard_charges":[{"minimum":811.79,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":811.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":811.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":811.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ULNA","code_information":[{"code":"25360","type":"CPT"}],"standard_charges":[{"minimum":698.78,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE RADIUS  ULNA","code_information":[{"code":"25365","type":"CPT"}],"standard_charges":[{"minimum":969.5,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISE RADIUS OR ULNA","code_information":[{"code":"25370","type":"CPT"}],"standard_charges":[{"minimum":1069.63,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE RADIUS  ULNA","code_information":[{"code":"25375","type":"CPT"}],"standard_charges":[{"minimum":1007.41,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHORTEN RADIUS OR ULNA","code_information":[{"code":"25390","type":"CPT"}],"standard_charges":[{"minimum":815.37,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"LENGTHEN RADIUS OR ULNA","code_information":[{"code":"25391","type":"CPT"}],"standard_charges":[{"minimum":1051.04,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"SHORTEN RADIUS  ULNA","code_information":[{"code":"25392","type":"CPT"}],"standard_charges":[{"minimum":1069.27,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"LENGTHEN RADIUS  ULNA","code_information":[{"code":"25393","type":"CPT"}],"standard_charges":[{"minimum":1189.08,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR CARPAL BONE SHORTEN","code_information":[{"code":"25394","type":"CPT"}],"standard_charges":[{"minimum":831.82,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR RADIUS OR ULNA","code_information":[{"code":"25400","type":"CPT"}],"standard_charges":[{"minimum":849.7,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":849.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":849.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":849.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT RADIUS OR ULNA","code_information":[{"code":"25405","type":"CPT"}],"standard_charges":[{"minimum":1093.59,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR RADIUS  ULNA","code_information":[{"code":"25415","type":"CPT"}],"standard_charges":[{"minimum":1022.07,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT RADIUS  ULNA","code_information":[{"code":"25420","type":"CPT"}],"standard_charges":[{"minimum":1228.06,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT RADIUS OR ULNA","code_information":[{"code":"25425","type":"CPT"}],"standard_charges":[{"minimum":1017.42,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT RADIUS  ULNA","code_information":[{"code":"25426","type":"CPT"}],"standard_charges":[{"minimum":1182.28,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"VASC GRAFT INTO CARPAL BONE","code_information":[{"code":"25430","type":"CPT"}],"standard_charges":[{"minimum":778.17,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR NONUNION CARPAL BONE","code_information":[{"code":"25431","type":"CPT"}],"standard_charges":[{"minimum":835.39,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT WRIST BONE","code_information":[{"code":"25440","type":"CPT"}],"standard_charges":[{"minimum":815.72,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25441","type":"CPT"}],"standard_charges":[{"minimum":991.31,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":991.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":991.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":991.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25442","type":"CPT"}],"standard_charges":[{"minimum":857.92,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25443","type":"CPT"}],"standard_charges":[{"minimum":833.61,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25444","type":"CPT"}],"standard_charges":[{"minimum":871.87,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25445","type":"CPT"}],"standard_charges":[{"minimum":765.3,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"WRIST REPLACEMENT","code_information":[{"code":"25446","type":"CPT"}],"standard_charges":[{"minimum":1235.21,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"REPAIR WRIST JOINTS","code_information":[{"code":"25447","type":"CPT"}],"standard_charges":[{"minimum":883.67,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":883.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":883.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":883.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE WRIST JOINT IMPLANT","code_information":[{"code":"25449","type":"CPT"}],"standard_charges":[{"minimum":1090.02,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF WRIST JOINT","code_information":[{"code":"25450","type":"CPT"}],"standard_charges":[{"minimum":658.73,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF WRIST JOINT","code_information":[{"code":"25455","type":"CPT"}],"standard_charges":[{"minimum":776.39,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REINFORCE RADIUS","code_information":[{"code":"25490","type":"CPT"}],"standard_charges":[{"minimum":763.87,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REINFORCE ULNA","code_information":[{"code":"25491","type":"CPT"}],"standard_charges":[{"minimum":784.97,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REINFORCE RADIUS AND ULNA","code_information":[{"code":"25492","type":"CPT"}],"standard_charges":[{"minimum":959.13,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25500","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25505","type":"CPT"}],"standard_charges":[{"minimum":499.59,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25515","type":"CPT"}],"standard_charges":[{"minimum":714.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25520","type":"CPT"}],"standard_charges":[{"minimum":587.21,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25525","type":"CPT"}],"standard_charges":[{"minimum":840.04,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25526","type":"CPT"}],"standard_charges":[{"minimum":1012.77,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF ULNA","code_information":[{"code":"25530","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF ULNA","code_information":[{"code":"25535","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE OF ULNA","code_information":[{"code":"25545","type":"CPT"}],"standard_charges":[{"minimum":666.96,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE RADIUS  ULNA","code_information":[{"code":"25560","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE RADIUS  ULNA","code_information":[{"code":"25565","type":"CPT"}],"standard_charges":[{"minimum":502.45,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE RADIUS  ULNA","code_information":[{"code":"25574","type":"CPT"}],"standard_charges":[{"minimum":719.17,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE RADIUS/ULNA","code_information":[{"code":"25575","type":"CPT"}],"standard_charges":[{"minimum":958.41,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE RADIUS/ULNA","code_information":[{"code":"25600","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE RADIUS/ULNA","code_information":[{"code":"25605","type":"CPT"}],"standard_charges":[{"minimum":551.8,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":551.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":551.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":551.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT FX DISTAL RADIAL","code_information":[{"code":"25606","type":"CPT"}],"standard_charges":[{"minimum":714.16,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FX RAD EXTRA-ARTICUL","code_information":[{"code":"25607","type":"CPT"}],"standard_charges":[{"minimum":788.55,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FX RAD INTRA-ARTICUL","code_information":[{"code":"25608","type":"CPT"}],"standard_charges":[{"minimum":880.1,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FX RADIAL 3+ FRAG","code_information":[{"code":"25609","type":"CPT"}],"standard_charges":[{"minimum":1114.33,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25622","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25624","type":"CPT"}],"standard_charges":[{"minimum":483.14,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25628","type":"CPT"}],"standard_charges":[{"minimum":764.59,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25630","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25635","type":"CPT"}],"standard_charges":[{"minimum":459.54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25645","type":"CPT"}],"standard_charges":[{"minimum":609.74,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25650","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"PIN ULNAR STYLOID FRACTURE","code_information":[{"code":"25651","type":"CPT"}],"standard_charges":[{"minimum":527.13,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FRACTURE ULNAR STYLOID","code_information":[{"code":"25652","type":"CPT"}],"standard_charges":[{"minimum":664.81,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25660","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25670","type":"CPT"}],"standard_charges":[{"minimum":647.64,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PIN RADIOULNAR DISLOCATION","code_information":[{"code":"25671","type":"CPT"}],"standard_charges":[{"minimum":573.98,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":573.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":573.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":573.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25675","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25676","type":"CPT"}],"standard_charges":[{"minimum":672.68,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST FRACTURE","code_information":[{"code":"25680","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST FRACTURE","code_information":[{"code":"25685","type":"CPT"}],"standard_charges":[{"minimum":780.68,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25690","type":"CPT"}],"standard_charges":[{"minimum":530.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25695","type":"CPT"}],"standard_charges":[{"minimum":675.54,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF WRIST JOINT","code_information":[{"code":"25800","type":"CPT"}],"standard_charges":[{"minimum":776.03,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION/GRAFT OF WRIST JOINT","code_information":[{"code":"25805","type":"CPT"}],"standard_charges":[{"minimum":897.98,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION/GRAFT OF WRIST JOINT","code_information":[{"code":"25810","type":"CPT"}],"standard_charges":[{"minimum":919.43,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":919.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":919.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":919.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"FUSION OF HAND BONES","code_information":[{"code":"25820","type":"CPT"}],"standard_charges":[{"minimum":690.56,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSE HAND BONES WITH GRAFT","code_information":[{"code":"25825","type":"CPT"}],"standard_charges":[{"minimum":842.55,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION RADIOULNAR JNT/ULNA","code_information":[{"code":"25830","type":"CPT"}],"standard_charges":[{"minimum":1088.59,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1088.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1088.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1088.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF FOREARM","code_information":[{"code":"25900","type":"CPT"}],"standard_charges":[{"minimum":761.37,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":761.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":761.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":761.37,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF FOREARM","code_information":[{"code":"25905","type":"CPT"}],"standard_charges":[{"minimum":745.27,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.27,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25907","type":"CPT"}],"standard_charges":[{"minimum":655.15,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25909","type":"CPT"}],"standard_charges":[{"minimum":727.75,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF FOREARM","code_information":[{"code":"25915","type":"CPT"}],"standard_charges":[{"minimum":1226.98,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1226.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1226.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1226.98,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE HAND AT WRIST","code_information":[{"code":"25920","type":"CPT"}],"standard_charges":[{"minimum":774.6,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.6,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE HAND AT WRIST","code_information":[{"code":"25922","type":"CPT"}],"standard_charges":[{"minimum":687.34,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25924","type":"CPT"}],"standard_charges":[{"minimum":756.72,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF HAND","code_information":[{"code":"25927","type":"CPT"}],"standard_charges":[{"minimum":913,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":913,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":913,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":913,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25929","type":"CPT"}],"standard_charges":[{"minimum":638.35,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25931","type":"CPT"}],"standard_charges":[{"minimum":845.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FOREARM OR WRIST SURGERY","code_information":[{"code":"25999","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF FINGER ABSCESS","code_information":[{"code":"26010","type":"CPT"}],"standard_charges":[{"minimum":150.2,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF FINGER ABSCESS","code_information":[{"code":"26011","type":"CPT"}],"standard_charges":[{"minimum":196.69,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DRAIN HAND TENDON SHEATH","code_information":[{"code":"26020","type":"CPT"}],"standard_charges":[{"minimum":593.64,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PALM BURSA","code_information":[{"code":"26025","type":"CPT"}],"standard_charges":[{"minimum":447.74,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PALM BURSAS","code_information":[{"code":"26030","type":"CPT"}],"standard_charges":[{"minimum":524.62,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT HAND BONE LESION","code_information":[{"code":"26034","type":"CPT"}],"standard_charges":[{"minimum":589,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":589,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":589,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":589,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS FINGERS/HAND","code_information":[{"code":"26035","type":"CPT"}],"standard_charges":[{"minimum":913.71,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS FINGERS/HAND","code_information":[{"code":"26037","type":"CPT"}],"standard_charges":[{"minimum":597.58,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26040","type":"CPT"}],"standard_charges":[{"minimum":340.81,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26045","type":"CPT"}],"standard_charges":[{"minimum":506.03,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISE FINGER TENDON SHEATH","code_information":[{"code":"26055","type":"CPT"}],"standard_charges":[{"minimum":313.27,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"INCISION OF FINGER TENDON","code_information":[{"code":"26060","type":"CPT"}],"standard_charges":[{"minimum":275.01,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT HAND JOINT","code_information":[{"code":"26070","type":"CPT"}],"standard_charges":[{"minimum":347.6,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT FINGER JOINT","code_information":[{"code":"26075","type":"CPT"}],"standard_charges":[{"minimum":364.05,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT FINGER JOINT","code_information":[{"code":"26080","type":"CPT"}],"standard_charges":[{"minimum":428.78,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"BIOPSY HAND JOINT LINING","code_information":[{"code":"26100","type":"CPT"}],"standard_charges":[{"minimum":365.84,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY FINGER JOINT LINING","code_information":[{"code":"26105","type":"CPT"}],"standard_charges":[{"minimum":367.99,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY FINGER JOINT LINING","code_information":[{"code":"26110","type":"CPT"}],"standard_charges":[{"minimum":350.46,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"EXC HAND LES SC 1.5 CM/>","code_information":[{"code":"26111","type":"CPT"}],"standard_charges":[{"minimum":443.45,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC HAND TUM DEEP 1.5 CM/>","code_information":[{"code":"26113","type":"CPT"}],"standard_charges":[{"minimum":583.27,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC HAND LES SC < 1.5 CM","code_information":[{"code":"26115","type":"CPT"}],"standard_charges":[{"minimum":355.83,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC HAND TUM DEEP < 1.5 CM","code_information":[{"code":"26116","type":"CPT"}],"standard_charges":[{"minimum":560.03,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"RAD RESECT HAND TUMOR < 3 CM","code_information":[{"code":"26117","type":"CPT"}],"standard_charges":[{"minimum":788.9,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RAD RESECT HAND TUMOR 3 CM/>","code_information":[{"code":"26118","type":"CPT"}],"standard_charges":[{"minimum":1106.11,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26121","type":"CPT"}],"standard_charges":[{"minimum":639.78,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":639.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":639.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":639.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26123","type":"CPT"}],"standard_charges":[{"minimum":891.54,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26125","type":"CPT"}],"standard_charges":[{"minimum":279.3,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE WRIST JOINT LINING","code_information":[{"code":"26130","type":"CPT"}],"standard_charges":[{"minimum":503.17,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE FINGER JOINT EACH","code_information":[{"code":"26135","type":"CPT"}],"standard_charges":[{"minimum":591.14,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE FINGER JOINT EACH","code_information":[{"code":"26140","type":"CPT"}],"standard_charges":[{"minimum":543.94,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TENDON EXCISION PALM/FINGER","code_information":[{"code":"26145","type":"CPT"}],"standard_charges":[{"minimum":552.16,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE TENDON SHEATH LESION","code_information":[{"code":"26160","type":"CPT"}],"standard_charges":[{"minimum":339.74,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PALM TENDON EACH","code_information":[{"code":"26170","type":"CPT"}],"standard_charges":[{"minimum":438.44,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FINGER TENDON","code_information":[{"code":"26180","type":"CPT"}],"standard_charges":[{"minimum":483.14,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE FINGER BONE","code_information":[{"code":"26185","type":"CPT"}],"standard_charges":[{"minimum":597.22,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE HAND BONE LESION","code_information":[{"code":"26200","type":"CPT"}],"standard_charges":[{"minimum":482.78,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"26205","type":"CPT"}],"standard_charges":[{"minimum":644.78,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":644.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":644.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":644.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FINGER LESION","code_information":[{"code":"26210","type":"CPT"}],"standard_charges":[{"minimum":480.99,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT FINGER LESION","code_information":[{"code":"26215","type":"CPT"}],"standard_charges":[{"minimum":605.45,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF HAND BONE","code_information":[{"code":"26230","type":"CPT"}],"standard_charges":[{"minimum":534.28,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL FINGER BONE","code_information":[{"code":"26235","type":"CPT"}],"standard_charges":[{"minimum":527.49,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL FINGER BONE","code_information":[{"code":"26236","type":"CPT"}],"standard_charges":[{"minimum":473.48,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE HAND SURGERY","code_information":[{"code":"26250","type":"CPT"}],"standard_charges":[{"minimum":1123.63,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT PROX FINGER TUMOR","code_information":[{"code":"26260","type":"CPT"}],"standard_charges":[{"minimum":843.26,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":843.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":843.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":843.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT DISTAL FINGER TUMOR","code_information":[{"code":"26262","type":"CPT"}],"standard_charges":[{"minimum":671.25,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF IMPLANT FROM HAND","code_information":[{"code":"26320","type":"CPT"}],"standard_charges":[{"minimum":374.78,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"MANIPULATE FINGER W/ANESTH","code_information":[{"code":"26340","type":"CPT"}],"standard_charges":[{"minimum":385.51,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"MANIPULAT PALM CORD POST INJ","code_information":[{"code":"26341","type":"CPT"}],"standard_charges":[{"minimum":82.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26350","type":"CPT"}],"standard_charges":[{"minimum":792.48,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26352","type":"CPT"}],"standard_charges":[{"minimum":881.17,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26356","type":"CPT"}],"standard_charges":[{"minimum":846.48,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26357","type":"CPT"}],"standard_charges":[{"minimum":946.61,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26358","type":"CPT"}],"standard_charges":[{"minimum":1042.81,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1042.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1042.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1042.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26370","type":"CPT"}],"standard_charges":[{"minimum":830.03,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26372","type":"CPT"}],"standard_charges":[{"minimum":968.43,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26373","type":"CPT"}],"standard_charges":[{"minimum":931.95,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE HAND/FINGER TENDON","code_information":[{"code":"26390","type":"CPT"}],"standard_charges":[{"minimum":928.73,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26392","type":"CPT"}],"standard_charges":[{"minimum":1058.55,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR HAND TENDON","code_information":[{"code":"26410","type":"CPT"}],"standard_charges":[{"minimum":638.7,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26412","type":"CPT"}],"standard_charges":[{"minimum":759.22,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXCISION HAND/FINGER TENDON","code_information":[{"code":"26415","type":"CPT"}],"standard_charges":[{"minimum":900.84,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"GRAFT HAND OR FINGER TENDON","code_information":[{"code":"26416","type":"CPT"}],"standard_charges":[{"minimum":974.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER TENDON","code_information":[{"code":"26418","type":"CPT"}],"standard_charges":[{"minimum":664.09,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT FINGER TENDON","code_information":[{"code":"26420","type":"CPT"}],"standard_charges":[{"minimum":787.83,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26426","type":"CPT"}],"standard_charges":[{"minimum":539.29,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT FINGER TENDON","code_information":[{"code":"26428","type":"CPT"}],"standard_charges":[{"minimum":844.33,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER TENDON","code_information":[{"code":"26432","type":"CPT"}],"standard_charges":[{"minimum":578.27,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER TENDON","code_information":[{"code":"26433","type":"CPT"}],"standard_charges":[{"minimum":607.23,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT FINGER TENDON","code_information":[{"code":"26434","type":"CPT"}],"standard_charges":[{"minimum":738.48,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REALIGNMENT OF TENDONS","code_information":[{"code":"26437","type":"CPT"}],"standard_charges":[{"minimum":708.08,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE PALM/FINGER TENDON","code_information":[{"code":"26440","type":"CPT"}],"standard_charges":[{"minimum":690.2,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"RELEASE PALM  FINGER TENDON","code_information":[{"code":"26442","type":"CPT"}],"standard_charges":[{"minimum":1049.25,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE HAND/FINGER TENDON","code_information":[{"code":"26445","type":"CPT"}],"standard_charges":[{"minimum":641.21,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE FOREARM/HAND TENDON","code_information":[{"code":"26449","type":"CPT"}],"standard_charges":[{"minimum":746.7,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF PALM TENDON","code_information":[{"code":"26450","type":"CPT"}],"standard_charges":[{"minimum":494.23,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF FINGER TENDON","code_information":[{"code":"26455","type":"CPT"}],"standard_charges":[{"minimum":491.01,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"INCISE HAND/FINGER TENDON","code_information":[{"code":"26460","type":"CPT"}],"standard_charges":[{"minimum":480.99,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FINGER TENDONS","code_information":[{"code":"26471","type":"CPT"}],"standard_charges":[{"minimum":701.29,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FINGER TENDONS","code_information":[{"code":"26474","type":"CPT"}],"standard_charges":[{"minimum":692.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TENDON LENGTHENING","code_information":[{"code":"26476","type":"CPT"}],"standard_charges":[{"minimum":684.48,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TENDON SHORTENING","code_information":[{"code":"26477","type":"CPT"}],"standard_charges":[{"minimum":668.74,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"LENGTHENING OF HAND TENDON","code_information":[{"code":"26478","type":"CPT"}],"standard_charges":[{"minimum":698.78,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHORTENING OF HAND TENDON","code_information":[{"code":"26479","type":"CPT"}],"standard_charges":[{"minimum":717.74,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT HAND TENDON","code_information":[{"code":"26480","type":"CPT"}],"standard_charges":[{"minimum":832.89,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT/GRAFT HAND TENDON","code_information":[{"code":"26483","type":"CPT"}],"standard_charges":[{"minimum":923.37,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT PALM TENDON","code_information":[{"code":"26485","type":"CPT"}],"standard_charges":[{"minimum":886.17,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT/GRAFT PALM TENDON","code_information":[{"code":"26489","type":"CPT"}],"standard_charges":[{"minimum":1019.92,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE THUMB TENDON","code_information":[{"code":"26490","type":"CPT"}],"standard_charges":[{"minimum":888.68,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TENDON TRANSFER WITH GRAFT","code_information":[{"code":"26492","type":"CPT"}],"standard_charges":[{"minimum":982.73,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"HAND TENDON/MUSCLE TRANSFER","code_information":[{"code":"26494","type":"CPT"}],"standard_charges":[{"minimum":892.61,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":892.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":892.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":892.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE THUMB TENDON","code_information":[{"code":"26496","type":"CPT"}],"standard_charges":[{"minimum":960.2,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FINGER TENDON TRANSFER","code_information":[{"code":"26497","type":"CPT"}],"standard_charges":[{"minimum":958.77,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FINGER TENDON TRANSFER","code_information":[{"code":"26498","type":"CPT"}],"standard_charges":[{"minimum":1244.86,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1244.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1244.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1244.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF FINGER","code_information":[{"code":"26499","type":"CPT"}],"standard_charges":[{"minimum":923.01,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"HAND TENDON RECONSTRUCTION","code_information":[{"code":"26500","type":"CPT"}],"standard_charges":[{"minimum":730.61,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"HAND TENDON RECONSTRUCTION","code_information":[{"code":"26502","type":"CPT"}],"standard_charges":[{"minimum":801.78,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE THUMB CONTRACTURE","code_information":[{"code":"26508","type":"CPT"}],"standard_charges":[{"minimum":719.53,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"THUMB TENDON TRANSFER","code_information":[{"code":"26510","type":"CPT"}],"standard_charges":[{"minimum":680.55,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF KNUCKLE JOINT","code_information":[{"code":"26516","type":"CPT"}],"standard_charges":[{"minimum":788.9,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF KNUCKLE JOINTS","code_information":[{"code":"26517","type":"CPT"}],"standard_charges":[{"minimum":917.65,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF KNUCKLE JOINTS","code_information":[{"code":"26518","type":"CPT"}],"standard_charges":[{"minimum":929.45,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RELEASE KNUCKLE CONTRACTURE","code_information":[{"code":"26520","type":"CPT"}],"standard_charges":[{"minimum":723.1,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE FINGER CONTRACTURE","code_information":[{"code":"26525","type":"CPT"}],"standard_charges":[{"minimum":727.39,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REVISE KNUCKLE JOINT","code_information":[{"code":"26530","type":"CPT"}],"standard_charges":[{"minimum":579.7,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE KNUCKLE WITH IMPLANT","code_information":[{"code":"26531","type":"CPT"}],"standard_charges":[{"minimum":673.75,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE FINGER JOINT","code_information":[{"code":"26535","type":"CPT"}],"standard_charges":[{"minimum":469.91,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE/IMPLANT FINGER JOINT","code_information":[{"code":"26536","type":"CPT"}],"standard_charges":[{"minimum":795.34,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR HAND JOINT","code_information":[{"code":"26540","type":"CPT"}],"standard_charges":[{"minimum":742.41,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR HAND JOINT WITH GRAFT","code_information":[{"code":"26541","type":"CPT"}],"standard_charges":[{"minimum":885.82,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR HAND JOINT WITH GRAFT","code_information":[{"code":"26542","type":"CPT"}],"standard_charges":[{"minimum":766.73,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT FINGER JOINT","code_information":[{"code":"26545","type":"CPT"}],"standard_charges":[{"minimum":780.32,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR NONUNION HAND","code_information":[{"code":"26546","type":"CPT"}],"standard_charges":[{"minimum":1099.67,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT FINGER JOINT","code_information":[{"code":"26548","type":"CPT"}],"standard_charges":[{"minimum":848.27,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCT THUMB REPLACEMENT","code_information":[{"code":"26550","type":"CPT"}],"standard_charges":[{"minimum":1736.95,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"GREAT TOE-HAND TRANSFER","code_information":[{"code":"26551","type":"CPT"}],"standard_charges":[{"minimum":3446,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3446,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3446,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3446,"methodology":"fee schedule"}]}]},{"description":"SINGLE TRANSFER TOE-HAND","code_information":[{"code":"26553","type":"CPT"}],"standard_charges":[{"minimum":3422.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3422.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3422.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3422.75,"methodology":"fee schedule"}]}]},{"description":"DOUBLE TRANSFER TOE-HAND","code_information":[{"code":"26554","type":"CPT"}],"standard_charges":[{"minimum":3982.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3982.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3982.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3982.78,"methodology":"fee schedule"}]}]},{"description":"POSITIONAL CHANGE OF FINGER","code_information":[{"code":"26555","type":"CPT"}],"standard_charges":[{"minimum":1460.87,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1460.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1460.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1460.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TOE JOINT TRANSFER","code_information":[{"code":"26556","type":"CPT"}],"standard_charges":[{"minimum":3561.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3561.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3561.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3561.15,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WEB FINGER","code_information":[{"code":"26560","type":"CPT"}],"standard_charges":[{"minimum":675.54,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WEB FINGER","code_information":[{"code":"26561","type":"CPT"}],"standard_charges":[{"minimum":1039.59,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WEB FINGER","code_information":[{"code":"26562","type":"CPT"}],"standard_charges":[{"minimum":1453.71,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1453.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1453.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1453.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CORRECT METACARPAL FLAW","code_information":[{"code":"26565","type":"CPT"}],"standard_charges":[{"minimum":754.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CORRECT FINGER DEFORMITY","code_information":[{"code":"26567","type":"CPT"}],"standard_charges":[{"minimum":763.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"LENGTHEN METACARPAL/FINGER","code_information":[{"code":"26568","type":"CPT"}],"standard_charges":[{"minimum":984.16,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR HAND DEFORMITY","code_information":[{"code":"26580","type":"CPT"}],"standard_charges":[{"minimum":1624.65,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT EXTRA FINGER","code_information":[{"code":"26587","type":"CPT"}],"standard_charges":[{"minimum":1103.25,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FINGER DEFORMITY","code_information":[{"code":"26590","type":"CPT"}],"standard_charges":[{"minimum":1508.43,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REPAIR MUSCLES OF HAND","code_information":[{"code":"26591","type":"CPT"}],"standard_charges":[{"minimum":520.33,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE MUSCLES OF HAND","code_information":[{"code":"26593","type":"CPT"}],"standard_charges":[{"minimum":684.84,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXCISION CONSTRICTING TISSUE","code_information":[{"code":"26596","type":"CPT"}],"standard_charges":[{"minimum":867.22,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26600","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26605","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":324.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":324.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":324.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26607","type":"CPT"}],"standard_charges":[{"minimum":543.22,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26608","type":"CPT"}],"standard_charges":[{"minimum":517.83,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26615","type":"CPT"}],"standard_charges":[{"minimum":615.1,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT THUMB DISLOCATION","code_information":[{"code":"26641","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT THUMB FRACTURE","code_information":[{"code":"26645","type":"CPT"}],"standard_charges":[{"minimum":428.43,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT THUMB FRACTURE","code_information":[{"code":"26650","type":"CPT"}],"standard_charges":[{"minimum":517.47,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT THUMB FRACTURE","code_information":[{"code":"26665","type":"CPT"}],"standard_charges":[{"minimum":669.1,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT HAND DISLOCATION","code_information":[{"code":"26670","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HAND DISLOCATION","code_information":[{"code":"26675","type":"CPT"}],"standard_charges":[{"minimum":457.75,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"PIN HAND DISLOCATION","code_information":[{"code":"26676","type":"CPT"}],"standard_charges":[{"minimum":548.23,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT HAND DISLOCATION","code_information":[{"code":"26685","type":"CPT"}],"standard_charges":[{"minimum":616.53,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT HAND DISLOCATION","code_information":[{"code":"26686","type":"CPT"}],"standard_charges":[{"minimum":663.38,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT KNUCKLE DISLOCATION","code_information":[{"code":"26700","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT KNUCKLE DISLOCATION","code_information":[{"code":"26705","type":"CPT"}],"standard_charges":[{"minimum":430.57,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"PIN KNUCKLE DISLOCATION","code_information":[{"code":"26706","type":"CPT"}],"standard_charges":[{"minimum":481.35,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT KNUCKLE DISLOCATION","code_information":[{"code":"26715","type":"CPT"}],"standard_charges":[{"minimum":612.96,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26720","type":"CPT"}],"standard_charges":[{"minimum":208.13,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26725","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26727","type":"CPT"}],"standard_charges":[{"minimum":510.32,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":510.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":510.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":510.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26735","type":"CPT"}],"standard_charges":[{"minimum":635.84,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26740","type":"CPT"}],"standard_charges":[{"minimum":242.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26742","type":"CPT"}],"standard_charges":[{"minimum":364.05,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26746","type":"CPT"}],"standard_charges":[{"minimum":788.55,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26750","type":"CPT"}],"standard_charges":[{"minimum":209.21,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26755","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"PIN FINGER FRACTURE EACH","code_information":[{"code":"26756","type":"CPT"}],"standard_charges":[{"minimum":457.03,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26765","type":"CPT"}],"standard_charges":[{"minimum":540,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":540,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":540,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":540,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER DISLOCATION","code_information":[{"code":"26770","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER DISLOCATION","code_information":[{"code":"26775","type":"CPT"}],"standard_charges":[{"minimum":283.06,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"PIN FINGER DISLOCATION","code_information":[{"code":"26776","type":"CPT"}],"standard_charges":[{"minimum":483.86,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FINGER DISLOCATION","code_information":[{"code":"26785","type":"CPT"}],"standard_charges":[{"minimum":585.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":585.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":585.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":585.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"THUMB FUSION WITH GRAFT","code_information":[{"code":"26820","type":"CPT"}],"standard_charges":[{"minimum":879.74,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF THUMB","code_information":[{"code":"26841","type":"CPT"}],"standard_charges":[{"minimum":822.88,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"THUMB FUSION WITH GRAFT","code_information":[{"code":"26842","type":"CPT"}],"standard_charges":[{"minimum":882.24,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF HAND JOINT","code_information":[{"code":"26843","type":"CPT"}],"standard_charges":[{"minimum":830.03,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION/GRAFT OF HAND JOINT","code_information":[{"code":"26844","type":"CPT"}],"standard_charges":[{"minimum":911.92,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":911.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":911.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":911.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF KNUCKLE","code_information":[{"code":"26850","type":"CPT"}],"standard_charges":[{"minimum":779.61,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF KNUCKLE WITH GRAFT","code_information":[{"code":"26852","type":"CPT"}],"standard_charges":[{"minimum":884.74,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FINGER JOINT","code_information":[{"code":"26860","type":"CPT"}],"standard_charges":[{"minimum":651.22,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":651.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":651.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":651.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FINGER JNT ADD-ON","code_information":[{"code":"26861","type":"CPT"}],"standard_charges":[{"minimum":105.85,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"}]}]},{"description":"FUSION/GRAFT OF FINGER JOINT","code_information":[{"code":"26862","type":"CPT"}],"standard_charges":[{"minimum":813.94,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSE/GRAFT ADDED JOINT","code_information":[{"code":"26863","type":"CPT"}],"standard_charges":[{"minimum":236.03,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE METACARPAL BONE","code_information":[{"code":"26910","type":"CPT"}],"standard_charges":[{"minimum":807.5,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF FINGER/THUMB","code_information":[{"code":"26951","type":"CPT"}],"standard_charges":[{"minimum":746.35,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF FINGER/THUMB","code_information":[{"code":"26952","type":"CPT"}],"standard_charges":[{"minimum":725.6,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"HAND/FINGER SURGERY","code_information":[{"code":"26989","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PELVIS LESION","code_information":[{"code":"26990","type":"CPT"}],"standard_charges":[{"minimum":720.96,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PELVIS BURSA","code_information":[{"code":"26991","type":"CPT"}],"standard_charges":[{"minimum":559.67,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF BONE LESION","code_information":[{"code":"26992","type":"CPT"}],"standard_charges":[{"minimum":1066.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.77,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HIP TENDON","code_information":[{"code":"27000","type":"CPT"}],"standard_charges":[{"minimum":416.62,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HIP TENDON","code_information":[{"code":"27001","type":"CPT"}],"standard_charges":[{"minimum":574.33,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HIP TENDON","code_information":[{"code":"27003","type":"CPT"}],"standard_charges":[{"minimum":638.35,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HIP TENDON","code_information":[{"code":"27005","type":"CPT"}],"standard_charges":[{"minimum":763.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.15,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HIP TENDONS","code_information":[{"code":"27006","type":"CPT"}],"standard_charges":[{"minimum":758.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HIP/THIGH FASCIA","code_information":[{"code":"27025","type":"CPT"}],"standard_charges":[{"minimum":980.59,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.59,"methodology":"fee schedule"}]}]},{"description":"BUTTOCK FASCIOTOMY","code_information":[{"code":"27027","type":"CPT"}],"standard_charges":[{"minimum":933.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF HIP JOINT","code_information":[{"code":"27030","type":"CPT"}],"standard_charges":[{"minimum":987.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":987.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":987.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":987.02,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF HIP JOINT","code_information":[{"code":"27033","type":"CPT"}],"standard_charges":[{"minimum":1023.86,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"DENERVATION OF HIP JOINT","code_information":[{"code":"27035","type":"CPT"}],"standard_charges":[{"minimum":1193.01,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1193.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1193.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1193.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF HIP JOINT/MUSCLE","code_information":[{"code":"27036","type":"CPT"}],"standard_charges":[{"minimum":1074.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.64,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF SOFT TISSUES","code_information":[{"code":"27040","type":"CPT"}],"standard_charges":[{"minimum":209.56,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF SOFT TISSUES","code_information":[{"code":"27041","type":"CPT"}],"standard_charges":[{"minimum":748.49,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC HIP PELVIS LES SC 3 CM/>","code_information":[{"code":"27043","type":"CPT"}],"standard_charges":[{"minimum":495.3,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC HIP/PELV TUM DEEP 5 CM/>","code_information":[{"code":"27045","type":"CPT"}],"standard_charges":[{"minimum":772.45,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC HIP/PELVIS LES SC < 3 CM","code_information":[{"code":"27047","type":"CPT"}],"standard_charges":[{"minimum":383.37,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC HIP/PELV TUM DEEP < 5 CM","code_information":[{"code":"27048","type":"CPT"}],"standard_charges":[{"minimum":646.93,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT HIP/PELV TUM < 5 CM","code_information":[{"code":"27049","type":"CPT"}],"standard_charges":[{"minimum":1495.2,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1495.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1495.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1495.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF SACROILIAC JOINT","code_information":[{"code":"27050","type":"CPT"}],"standard_charges":[{"minimum":435.22,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF HIP JOINT","code_information":[{"code":"27052","type":"CPT"}],"standard_charges":[{"minimum":617.6,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HIP JOINT LINING","code_information":[{"code":"27054","type":"CPT"}],"standard_charges":[{"minimum":730.97,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.97,"methodology":"fee schedule"}]}]},{"description":"BUTTOCK FASCIOTOMY W/DBRDMT","code_information":[{"code":"27057","type":"CPT"}],"standard_charges":[{"minimum":1060.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"RESECT HIP/PELV TUM 5 CM/>","code_information":[{"code":"27059","type":"CPT"}],"standard_charges":[{"minimum":1894.3,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ISCHIAL BURSA","code_information":[{"code":"27060","type":"CPT"}],"standard_charges":[{"minimum":498.16,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE FEMUR LESION/BURSA","code_information":[{"code":"27062","type":"CPT"}],"standard_charges":[{"minimum":484.93,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP BONE LES SUPER","code_information":[{"code":"27065","type":"CPT"}],"standard_charges":[{"minimum":557.88,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP BONE LES DEEP","code_information":[{"code":"27066","type":"CPT"}],"standard_charges":[{"minimum":863.65,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":863.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":863.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":863.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT HIP BONE LESION","code_information":[{"code":"27067","type":"CPT"}],"standard_charges":[{"minimum":1092.88,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PART REMOVE HIP BONE SUPER","code_information":[{"code":"27070","type":"CPT"}],"standard_charges":[{"minimum":934.1,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.1,"methodology":"fee schedule"}]}]},{"description":"PART REMOVAL HIP BONE DEEP","code_information":[{"code":"27071","type":"CPT"}],"standard_charges":[{"minimum":1025.65,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.65,"methodology":"fee schedule"}]}]},{"description":"RESECT HIP TUMOR","code_information":[{"code":"27075","type":"CPT"}],"standard_charges":[{"minimum":2175.03,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2175.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2175.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2175.03,"methodology":"fee schedule"}]}]},{"description":"RESECT HIP TUM INCL ACETABUL","code_information":[{"code":"27076","type":"CPT"}],"standard_charges":[{"minimum":2625.62,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2625.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2625.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2625.62,"methodology":"fee schedule"}]}]},{"description":"RESECT HIP TUM W/INNOM BONE","code_information":[{"code":"27077","type":"CPT"}],"standard_charges":[{"minimum":2926.74,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2926.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2926.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2926.74,"methodology":"fee schedule"}]}]},{"description":"RSECT HIP TUM INCL FEMUR","code_information":[{"code":"27078","type":"CPT"}],"standard_charges":[{"minimum":2144.99,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2144.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2144.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2144.99,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TAIL BONE","code_information":[{"code":"27080","type":"CPT"}],"standard_charges":[{"minimum":538.57,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP FOREIGN BODY","code_information":[{"code":"27086","type":"CPT"}],"standard_charges":[{"minimum":179.52,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE HIP FOREIGN BODY","code_information":[{"code":"27087","type":"CPT"}],"standard_charges":[{"minimum":650.51,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HIP PROSTHESIS","code_information":[{"code":"27090","type":"CPT"}],"standard_charges":[{"minimum":876.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.52,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HIP PROSTHESIS","code_information":[{"code":"27091","type":"CPT"}],"standard_charges":[{"minimum":1668.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR HIP X-RAY","code_information":[{"code":"27093","type":"CPT"}],"standard_charges":[{"minimum":70.45,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.45,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR HIP X-RAY","code_information":[{"code":"27095","type":"CPT"}],"standard_charges":[{"minimum":85.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"}]}]},{"description":"INJECT SACROILIAC JOINT","code_information":[{"code":"27096","type":"CPT"}],"standard_charges":[{"minimum":86.9,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HIP TENDON","code_information":[{"code":"27097","type":"CPT"}],"standard_charges":[{"minimum":725.25,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSFER TENDON TO PELVIS","code_information":[{"code":"27098","type":"CPT"}],"standard_charges":[{"minimum":738.48,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSFER OF ABDOMINAL MUSCLE","code_information":[{"code":"27100","type":"CPT"}],"standard_charges":[{"minimum":879.38,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TRANSFER OF SPINAL MUSCLE","code_information":[{"code":"27105","type":"CPT"}],"standard_charges":[{"minimum":921.22,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSFER OF ILIOPSOAS MUSCLE","code_information":[{"code":"27110","type":"CPT"}],"standard_charges":[{"minimum":1024.93,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TRANSFER OF ILIOPSOAS MUSCLE","code_information":[{"code":"27111","type":"CPT"}],"standard_charges":[{"minimum":955.2,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":955.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":955.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":955.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF HIP SOCKET","code_information":[{"code":"27120","type":"CPT"}],"standard_charges":[{"minimum":1364.31,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1364.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1364.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1364.31,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF HIP SOCKET","code_information":[{"code":"27122","type":"CPT"}],"standard_charges":[{"minimum":1161.54,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.54,"methodology":"fee schedule"}]}]},{"description":"PARTIAL HIP REPLACEMENT","code_information":[{"code":"27125","type":"CPT"}],"standard_charges":[{"minimum":1190.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.15,"methodology":"fee schedule"}]}]},{"description":"TOTAL HIP ARTHROPLASTY","code_information":[{"code":"27130","type":"CPT"}],"standard_charges":[{"minimum":1347.14,"maximum":16409.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16409.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12308.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12308.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1347.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1347.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1347.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TOTAL HIP ARTHROPLASTY","code_information":[{"code":"27132","type":"CPT"}],"standard_charges":[{"minimum":1749.1,"maximum":16409.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16409.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12308.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12308.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1749.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1749.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1749.1,"methodology":"fee schedule"}]}]},{"description":"REVISE HIP JOINT REPLACEMENT","code_information":[{"code":"27134","type":"CPT"}],"standard_charges":[{"minimum":1989.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1989.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1989.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1989.07,"methodology":"fee schedule"}]}]},{"description":"REVISE HIP JOINT REPLACEMENT","code_information":[{"code":"27137","type":"CPT"}],"standard_charges":[{"minimum":1533.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"}]}]},{"description":"REVISE HIP JOINT REPLACEMENT","code_information":[{"code":"27138","type":"CPT"}],"standard_charges":[{"minimum":1592.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.83,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT FEMUR RIDGE","code_information":[{"code":"27140","type":"CPT"}],"standard_charges":[{"minimum":946.97,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.97,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HIP BONE","code_information":[{"code":"27146","type":"CPT"}],"standard_charges":[{"minimum":1344.28,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HIP BONE","code_information":[{"code":"27147","type":"CPT"}],"standard_charges":[{"minimum":1534.18,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1534.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1534.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1534.18,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HIP BONES","code_information":[{"code":"27151","type":"CPT"}],"standard_charges":[{"minimum":1656.48,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1656.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1656.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1656.48,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HIP BONES","code_information":[{"code":"27156","type":"CPT"}],"standard_charges":[{"minimum":1783.79,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1783.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1783.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1783.79,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PELVIS","code_information":[{"code":"27158","type":"CPT"}],"standard_charges":[{"minimum":1468.02,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.02,"methodology":"fee schedule"}]}]},{"description":"INCISION OF NECK OF FEMUR","code_information":[{"code":"27161","type":"CPT"}],"standard_charges":[{"minimum":1283.13,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1283.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1283.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1283.13,"methodology":"fee schedule"}]}]},{"description":"INCISION/FIXATION OF FEMUR","code_information":[{"code":"27165","type":"CPT"}],"standard_charges":[{"minimum":1440.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1440.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1440.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1440.84,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT FEMUR HEAD/NECK","code_information":[{"code":"27170","type":"CPT"}],"standard_charges":[{"minimum":1228.41,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.41,"methodology":"fee schedule"}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27175","type":"CPT"}],"standard_charges":[{"minimum":705.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.94,"methodology":"fee schedule"}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27176","type":"CPT"}],"standard_charges":[{"minimum":974.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.15,"methodology":"fee schedule"}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27177","type":"CPT"}],"standard_charges":[{"minimum":1175.49,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.49,"methodology":"fee schedule"}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27178","type":"CPT"}],"standard_charges":[{"minimum":974.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.15,"methodology":"fee schedule"}]}]},{"description":"REVISE HEAD/NECK OF FEMUR","code_information":[{"code":"27179","type":"CPT"}],"standard_charges":[{"minimum":1032.08,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27181","type":"CPT"}],"standard_charges":[{"minimum":1180.14,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.14,"methodology":"fee schedule"}]}]},{"description":"REVISION OF FEMUR EPIPHYSIS","code_information":[{"code":"27185","type":"CPT"}],"standard_charges":[{"minimum":762.44,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"}]}]},{"description":"REINFORCE HIP BONES","code_information":[{"code":"27187","type":"CPT"}],"standard_charges":[{"minimum":1050.68,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"}]}]},{"description":"CLSD TX PELVIC RING FX","code_information":[{"code":"27197","type":"CPT"}],"standard_charges":[{"minimum":140.9,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"CLSD TX PELVIC RING FX","code_information":[{"code":"27198","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":391.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":391.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT TAIL BONE FRACTURE","code_information":[{"code":"27200","type":"CPT"}],"standard_charges":[{"minimum":208.49,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT TAIL BONE FRACTURE","code_information":[{"code":"27202","type":"CPT"}],"standard_charges":[{"minimum":560.39,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT PELVIC FRACTURE(S)","code_information":[{"code":"27215","type":"CPT"}],"standard_charges":[{"minimum":638.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.35,"methodology":"fee schedule"}]}]},{"description":"TREAT PELVIC RING FRACTURE","code_information":[{"code":"27216","type":"CPT"}],"standard_charges":[{"minimum":943.04,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"}]}]},{"description":"TREAT PELVIC RING FRACTURE","code_information":[{"code":"27217","type":"CPT"}],"standard_charges":[{"minimum":886.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.53,"methodology":"fee schedule"}]}]},{"description":"TREAT PELVIC RING FRACTURE","code_information":[{"code":"27218","type":"CPT"}],"standard_charges":[{"minimum":1215.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1215.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1215.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1215.54,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP SOCKET FRACTURE","code_information":[{"code":"27220","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP SOCKET FRACTURE","code_information":[{"code":"27222","type":"CPT"}],"standard_charges":[{"minimum":1033.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1033.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1033.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1033.51,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP WALL FRACTURE","code_information":[{"code":"27226","type":"CPT"}],"standard_charges":[{"minimum":1113.62,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1113.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1113.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1113.62,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP FRACTURE(S)","code_information":[{"code":"27227","type":"CPT"}],"standard_charges":[{"minimum":1728.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1728.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1728.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1728.72,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP FRACTURE(S)","code_information":[{"code":"27228","type":"CPT"}],"standard_charges":[{"minimum":1963.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1963.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1963.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1963.32,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27230","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27232","type":"CPT"}],"standard_charges":[{"minimum":765.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.66,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27235","type":"CPT"}],"standard_charges":[{"minimum":956.63,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27236","type":"CPT"}],"standard_charges":[{"minimum":1254.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1254.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1254.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1254.88,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27238","type":"CPT"}],"standard_charges":[{"minimum":501.74,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1605.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27240","type":"CPT"}],"standard_charges":[{"minimum":1004.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.9,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27244","type":"CPT"}],"standard_charges":[{"minimum":1290.28,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1290.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1290.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1290.28,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27245","type":"CPT"}],"standard_charges":[{"minimum":1288.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1288.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1288.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1288.49,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27246","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1605.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27248","type":"CPT"}],"standard_charges":[{"minimum":786.04,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.04,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27250","type":"CPT"}],"standard_charges":[{"minimum":187.39,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27252","type":"CPT"}],"standard_charges":[{"minimum":791.41,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27253","type":"CPT"}],"standard_charges":[{"minimum":990.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.24,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27254","type":"CPT"}],"standard_charges":[{"minimum":1335.7,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1335.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1335.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1335.7,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27256","type":"CPT"}],"standard_charges":[{"minimum":253.19,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27257","type":"CPT"}],"standard_charges":[{"minimum":380.5,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27258","type":"CPT"}],"standard_charges":[{"minimum":1170.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1170.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1170.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1170.48,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27259","type":"CPT"}],"standard_charges":[{"minimum":1618.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27265","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27266","type":"CPT"}],"standard_charges":[{"minimum":620.47,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"CLTX THIGH FX","code_information":[{"code":"27267","type":"CPT"}],"standard_charges":[{"minimum":313.03,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CLTX THIGH FX W/MNPJ","code_information":[{"code":"27268","type":"CPT"}],"standard_charges":[{"minimum":580.77,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.77,"methodology":"fee schedule"}]}]},{"description":"OPTX THIGH FX","code_information":[{"code":"27269","type":"CPT"}],"standard_charges":[{"minimum":1300.65,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1300.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1300.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1300.65,"methodology":"fee schedule"}]}]},{"description":"MANIPULATION OF HIP JOINT","code_information":[{"code":"27275","type":"CPT"}],"standard_charges":[{"minimum":195.62,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"ARTHRODESIS SACROILIAC JOINT","code_information":[{"code":"27279","type":"CPT"}],"standard_charges":[{"minimum":842.9,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"FUSION OF SACROILIAC JOINT","code_information":[{"code":"27280","type":"CPT"}],"standard_charges":[{"minimum":1426.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1426.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1426.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1426.53,"methodology":"fee schedule"}]}]},{"description":"FUSION OF PUBIC BONES","code_information":[{"code":"27282","type":"CPT"}],"standard_charges":[{"minimum":909.78,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.78,"methodology":"fee schedule"}]}]},{"description":"FUSION OF HIP JOINT","code_information":[{"code":"27284","type":"CPT"}],"standard_charges":[{"minimum":1677.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1677.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1677.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1677.58,"methodology":"fee schedule"}]}]},{"description":"FUSION OF HIP JOINT","code_information":[{"code":"27286","type":"CPT"}],"standard_charges":[{"minimum":1720.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1720.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1720.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1720.14,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF LEG AT HIP","code_information":[{"code":"27290","type":"CPT"}],"standard_charges":[{"minimum":1702.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.26,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF LEG AT HIP","code_information":[{"code":"27295","type":"CPT"}],"standard_charges":[{"minimum":1322.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1322.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1322.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1322.47,"methodology":"fee schedule"}]}]},{"description":"PELVIS/HIP JOINT SURGERY","code_information":[{"code":"27299","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"DRAIN THIGH/KNEE LESION","code_information":[{"code":"27301","type":"CPT"}],"standard_charges":[{"minimum":540,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":540,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":540,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":540,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF BONE LESION","code_information":[{"code":"27303","type":"CPT"}],"standard_charges":[{"minimum":680.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.9,"methodology":"fee schedule"}]}]},{"description":"INCISE THIGH TENDON  FASCIA","code_information":[{"code":"27305","type":"CPT"}],"standard_charges":[{"minimum":515.33,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF THIGH TENDON","code_information":[{"code":"27306","type":"CPT"}],"standard_charges":[{"minimum":367.63,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF THIGH TENDONS","code_information":[{"code":"27307","type":"CPT"}],"standard_charges":[{"minimum":435.94,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF KNEE JOINT","code_information":[{"code":"27310","type":"CPT"}],"standard_charges":[{"minimum":777.46,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY THIGH SOFT TISSUES","code_information":[{"code":"27323","type":"CPT"}],"standard_charges":[{"minimum":184.89,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY THIGH SOFT TISSUES","code_information":[{"code":"27324","type":"CPT"}],"standard_charges":[{"minimum":437.01,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"NEURECTOMY HAMSTRING","code_information":[{"code":"27325","type":"CPT"}],"standard_charges":[{"minimum":602.23,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"NEURECTOMY POPLITEAL","code_information":[{"code":"27326","type":"CPT"}],"standard_charges":[{"minimum":558.24,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"EXC THIGH/KNEE LES SC < 3 CM","code_information":[{"code":"27327","type":"CPT"}],"standard_charges":[{"minimum":335.09,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC THIGH/KNEE TUM DEEP <5CM","code_information":[{"code":"27328","type":"CPT"}],"standard_charges":[{"minimum":659.8,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT THIGH/KNEE TUM < 5 CM","code_information":[{"code":"27329","type":"CPT"}],"standard_charges":[{"minimum":1092.52,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"BIOPSY KNEE JOINT LINING","code_information":[{"code":"27330","type":"CPT"}],"standard_charges":[{"minimum":453.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT KNEE JOINT","code_information":[{"code":"27331","type":"CPT"}],"standard_charges":[{"minimum":509.6,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":509.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":509.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":509.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KNEE CARTILAGE","code_information":[{"code":"27332","type":"CPT"}],"standard_charges":[{"minimum":687.34,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KNEE CARTILAGE","code_information":[{"code":"27333","type":"CPT"}],"standard_charges":[{"minimum":628.69,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE KNEE JOINT LINING","code_information":[{"code":"27334","type":"CPT"}],"standard_charges":[{"minimum":729.18,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE KNEE JOINT LINING","code_information":[{"code":"27335","type":"CPT"}],"standard_charges":[{"minimum":812.51,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"EXC THIGH/KNEE LES SC 3 CM/>","code_information":[{"code":"27337","type":"CPT"}],"standard_charges":[{"minimum":443.45,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC THIGH/KNEE TUM DEP 5CM/>","code_information":[{"code":"27339","type":"CPT"}],"standard_charges":[{"minimum":796.41,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KNEECAP BURSA","code_information":[{"code":"27340","type":"CPT"}],"standard_charges":[{"minimum":402.68,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KNEE CYST","code_information":[{"code":"27345","type":"CPT"}],"standard_charges":[{"minimum":519.62,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE KNEE CYST","code_information":[{"code":"27347","type":"CPT"}],"standard_charges":[{"minimum":562.89,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KNEECAP","code_information":[{"code":"27350","type":"CPT"}],"standard_charges":[{"minimum":696.28,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE FEMUR LESION","code_information":[{"code":"27355","type":"CPT"}],"standard_charges":[{"minimum":646.93,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE FEMUR LESION/GRAFT","code_information":[{"code":"27356","type":"CPT"}],"standard_charges":[{"minimum":785.68,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REMOVE FEMUR LESION/GRAFT","code_information":[{"code":"27357","type":"CPT"}],"standard_charges":[{"minimum":866.86,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":866.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":866.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":866.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE FEMUR LESION/FIXATION","code_information":[{"code":"27358","type":"CPT"}],"standard_charges":[{"minimum":284.31,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL LEG BONE(S)","code_information":[{"code":"27360","type":"CPT"}],"standard_charges":[{"minimum":954.84,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT THIGH/KNEE TUM 5 CM/>","code_information":[{"code":"27364","type":"CPT"}],"standard_charges":[{"minimum":1636.1,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1636.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1636.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1636.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT FEMUR/KNEE TUMOR","code_information":[{"code":"27365","type":"CPT"}],"standard_charges":[{"minimum":2144.27,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2144.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2144.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2144.27,"methodology":"fee schedule"}]}]},{"description":"NJX CNTRST KNE ARTHG/CT/MRI","code_information":[{"code":"27369","type":"CPT"}],"standard_charges":[{"minimum":41.84,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":278.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":278.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOREIGN BODY","code_information":[{"code":"27372","type":"CPT"}],"standard_charges":[{"minimum":424.85,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF KNEECAP TENDON","code_information":[{"code":"27380","type":"CPT"}],"standard_charges":[{"minimum":662.31,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":662.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":662.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":662.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT KNEECAP TENDON","code_information":[{"code":"27381","type":"CPT"}],"standard_charges":[{"minimum":868.65,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":868.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":868.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":868.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF THIGH MUSCLE","code_information":[{"code":"27385","type":"CPT"}],"standard_charges":[{"minimum":646.21,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT OF THIGH MUSCLE","code_information":[{"code":"27386","type":"CPT"}],"standard_charges":[{"minimum":906.92,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF THIGH TENDON","code_information":[{"code":"27390","type":"CPT"}],"standard_charges":[{"minimum":482.43,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF THIGH TENDONS","code_information":[{"code":"27391","type":"CPT"}],"standard_charges":[{"minimum":617.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF THIGH TENDONS","code_information":[{"code":"27392","type":"CPT"}],"standard_charges":[{"minimum":758.15,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"LENGTHENING OF THIGH TENDON","code_information":[{"code":"27393","type":"CPT"}],"standard_charges":[{"minimum":535,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":535,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":535,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":535,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"LENGTHENING OF THIGH TENDONS","code_information":[{"code":"27394","type":"CPT"}],"standard_charges":[{"minimum":696.64,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"LENGTHENING OF THIGH TENDONS","code_information":[{"code":"27395","type":"CPT"}],"standard_charges":[{"minimum":933.74,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT OF THIGH TENDON","code_information":[{"code":"27396","type":"CPT"}],"standard_charges":[{"minimum":658.37,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANTS OF THIGH TENDONS","code_information":[{"code":"27397","type":"CPT"}],"standard_charges":[{"minimum":968.43,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE THIGH MUSCLES/TENDONS","code_information":[{"code":"27400","type":"CPT"}],"standard_charges":[{"minimum":739.19,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF KNEE CARTILAGE","code_information":[{"code":"27403","type":"CPT"}],"standard_charges":[{"minimum":686.27,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF KNEE LIGAMENT","code_information":[{"code":"27405","type":"CPT"}],"standard_charges":[{"minimum":718.81,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF KNEE LIGAMENT","code_information":[{"code":"27407","type":"CPT"}],"standard_charges":[{"minimum":845.05,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF KNEE LIGAMENTS","code_information":[{"code":"27409","type":"CPT"}],"standard_charges":[{"minimum":1021,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"AUTOCHONDROCYTE IMPLANT KNEE","code_information":[{"code":"27412","type":"CPT"}],"standard_charges":[{"minimum":1728.36,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1728.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1728.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1728.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"OSTEOCHONDRAL KNEE ALLOGRAFT","code_information":[{"code":"27415","type":"CPT"}],"standard_charges":[{"minimum":1443.7,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"OSTEOCHONDRAL KNEE AUTOGRAFT","code_information":[{"code":"27416","type":"CPT"}],"standard_charges":[{"minimum":1033.87,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1033.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1033.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1033.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEGENERATED KNEECAP","code_information":[{"code":"27418","type":"CPT"}],"standard_charges":[{"minimum":870.08,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF UNSTABLE KNEECAP","code_information":[{"code":"27420","type":"CPT"}],"standard_charges":[{"minimum":795.7,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF UNSTABLE KNEECAP","code_information":[{"code":"27422","type":"CPT"}],"standard_charges":[{"minimum":786.76,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION/REMOVAL OF KNEECAP","code_information":[{"code":"27424","type":"CPT"}],"standard_charges":[{"minimum":794.27,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"LAT RETINACULAR RELEASE OPEN","code_information":[{"code":"27425","type":"CPT"}],"standard_charges":[{"minimum":486.72,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION KNEE","code_information":[{"code":"27427","type":"CPT"}],"standard_charges":[{"minimum":751.71,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION KNEE","code_information":[{"code":"27428","type":"CPT"}],"standard_charges":[{"minimum":1180.14,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION KNEE","code_information":[{"code":"27429","type":"CPT"}],"standard_charges":[{"minimum":1329.98,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF THIGH MUSCLES","code_information":[{"code":"27430","type":"CPT"}],"standard_charges":[{"minimum":787.83,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF KNEE JOINT","code_information":[{"code":"27435","type":"CPT"}],"standard_charges":[{"minimum":855.78,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE KNEECAP","code_information":[{"code":"27437","type":"CPT"}],"standard_charges":[{"minimum":703.08,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE KNEECAP WITH IMPLANT","code_information":[{"code":"27438","type":"CPT"}],"standard_charges":[{"minimum":889.39,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27440","type":"CPT"}],"standard_charges":[{"minimum":845.05,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27441","type":"CPT"}],"standard_charges":[{"minimum":871.87,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27442","type":"CPT"}],"standard_charges":[{"minimum":918,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":918,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":918,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":918,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27443","type":"CPT"}],"standard_charges":[{"minimum":864.36,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27445","type":"CPT"}],"standard_charges":[{"minimum":1317.82,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27446","type":"CPT"}],"standard_charges":[{"minimum":1206.24,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8698.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6525.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6525.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1206.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1206.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1206.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TOTAL KNEE ARTHROPLASTY","code_information":[{"code":"27447","type":"CPT"}],"standard_charges":[{"minimum":1345,"maximum":16409.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16409.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12308.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12308.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1345,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1345,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"INCISION OF THIGH","code_information":[{"code":"27448","type":"CPT"}],"standard_charges":[{"minimum":875.8,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.8,"methodology":"fee schedule"}]}]},{"description":"INCISION OF THIGH","code_information":[{"code":"27450","type":"CPT"}],"standard_charges":[{"minimum":1064.27,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"}]}]},{"description":"REALIGNMENT OF THIGH BONE","code_information":[{"code":"27454","type":"CPT"}],"standard_charges":[{"minimum":1359.66,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1359.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1359.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1359.66,"methodology":"fee schedule"}]}]},{"description":"REALIGNMENT OF KNEE","code_information":[{"code":"27455","type":"CPT"}],"standard_charges":[{"minimum":1013.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.84,"methodology":"fee schedule"}]}]},{"description":"REALIGNMENT OF KNEE","code_information":[{"code":"27457","type":"CPT"}],"standard_charges":[{"minimum":995.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.25,"methodology":"fee schedule"}]}]},{"description":"SHORTENING OF THIGH BONE","code_information":[{"code":"27465","type":"CPT"}],"standard_charges":[{"minimum":1310.67,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1310.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1310.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1310.67,"methodology":"fee schedule"}]}]},{"description":"LENGTHENING OF THIGH BONE","code_information":[{"code":"27466","type":"CPT"}],"standard_charges":[{"minimum":1247.01,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.01,"methodology":"fee schedule"}]}]},{"description":"SHORTEN/LENGTHEN THIGHS","code_information":[{"code":"27468","type":"CPT"}],"standard_charges":[{"minimum":1407.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.94,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF THIGH","code_information":[{"code":"27470","type":"CPT"}],"standard_charges":[{"minimum":1243.43,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT OF THIGH","code_information":[{"code":"27472","type":"CPT"}],"standard_charges":[{"minimum":1329.62,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.62,"methodology":"fee schedule"}]}]},{"description":"SURGERY TO STOP LEG GROWTH","code_information":[{"code":"27475","type":"CPT"}],"standard_charges":[{"minimum":705.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SURGERY TO STOP LEG GROWTH","code_information":[{"code":"27477","type":"CPT"}],"standard_charges":[{"minimum":777.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SURGERY TO STOP LEG GROWTH","code_information":[{"code":"27479","type":"CPT"}],"standard_charges":[{"minimum":969.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SURGERY TO STOP LEG GROWTH","code_information":[{"code":"27485","type":"CPT"}],"standard_charges":[{"minimum":713.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE/REPLACE KNEE JOINT","code_information":[{"code":"27486","type":"CPT"}],"standard_charges":[{"minimum":1473.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1473.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1473.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1473.02,"methodology":"fee schedule"}]}]},{"description":"REVISE/REPLACE KNEE JOINT","code_information":[{"code":"27487","type":"CPT"}],"standard_charges":[{"minimum":1834.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1834.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1834.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1834.58,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KNEE PROSTHESIS","code_information":[{"code":"27488","type":"CPT"}],"standard_charges":[{"minimum":1262.75,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1262.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1262.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1262.75,"methodology":"fee schedule"}]}]},{"description":"REINFORCE THIGH","code_information":[{"code":"27495","type":"CPT"}],"standard_charges":[{"minimum":1189.08,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF THIGH/KNEE","code_information":[{"code":"27496","type":"CPT"}],"standard_charges":[{"minimum":586.49,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF THIGH/KNEE","code_information":[{"code":"27497","type":"CPT"}],"standard_charges":[{"minimum":617.96,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF THIGH/KNEE","code_information":[{"code":"27498","type":"CPT"}],"standard_charges":[{"minimum":699.14,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF THIGH/KNEE","code_information":[{"code":"27499","type":"CPT"}],"standard_charges":[{"minimum":745.99,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27500","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1605.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27501","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27502","type":"CPT"}],"standard_charges":[{"minimum":796.77,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27503","type":"CPT"}],"standard_charges":[{"minimum":846.48,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27506","type":"CPT"}],"standard_charges":[{"minimum":1406.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.87,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27507","type":"CPT"}],"standard_charges":[{"minimum":1017.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.06,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27508","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27509","type":"CPT"}],"standard_charges":[{"minimum":717.38,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27510","type":"CPT"}],"standard_charges":[{"minimum":723.82,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27511","type":"CPT"}],"standard_charges":[{"minimum":1045.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27513","type":"CPT"}],"standard_charges":[{"minimum":1293.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27514","type":"CPT"}],"standard_charges":[{"minimum":1014.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FX GROWTH PLATE","code_information":[{"code":"27516","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FX GROWTH PLATE","code_information":[{"code":"27517","type":"CPT"}],"standard_charges":[{"minimum":734.55,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT THIGH FX GROWTH PLATE","code_information":[{"code":"27519","type":"CPT"}],"standard_charges":[{"minimum":936.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.24,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEECAP FRACTURE","code_information":[{"code":"27520","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEECAP FRACTURE","code_information":[{"code":"27524","type":"CPT"}],"standard_charges":[{"minimum":798.2,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":798.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27530","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27532","type":"CPT"}],"standard_charges":[{"minimum":620.11,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27535","type":"CPT"}],"standard_charges":[{"minimum":943.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27536","type":"CPT"}],"standard_charges":[{"minimum":1249.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1249.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1249.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1249.87,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE FRACTURE(S)","code_information":[{"code":"27538","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27540","type":"CPT"}],"standard_charges":[{"minimum":861.14,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.14,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27550","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27552","type":"CPT"}],"standard_charges":[{"minimum":676.97,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27556","type":"CPT"}],"standard_charges":[{"minimum":921.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.58,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27557","type":"CPT"}],"standard_charges":[{"minimum":1095.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27558","type":"CPT"}],"standard_charges":[{"minimum":1245.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.22,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEECAP DISLOCATION","code_information":[{"code":"27560","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEECAP DISLOCATION","code_information":[{"code":"27562","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT KNEECAP DISLOCATION","code_information":[{"code":"27566","type":"CPT"}],"standard_charges":[{"minimum":943.39,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FIXATION OF KNEE JOINT","code_information":[{"code":"27570","type":"CPT"}],"standard_charges":[{"minimum":163.79,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"FUSION OF KNEE","code_information":[{"code":"27580","type":"CPT"}],"standard_charges":[{"minimum":1551.7,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1551.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1551.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1551.7,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE LEG AT THIGH","code_information":[{"code":"27590","type":"CPT"}],"standard_charges":[{"minimum":815.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.37,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE LEG AT THIGH","code_information":[{"code":"27591","type":"CPT"}],"standard_charges":[{"minimum":1015.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE LEG AT THIGH","code_information":[{"code":"27592","type":"CPT"}],"standard_charges":[{"minimum":698.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.43,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"27594","type":"CPT"}],"standard_charges":[{"minimum":529.99,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"27596","type":"CPT"}],"standard_charges":[{"minimum":742.41,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE LOWER LEG AT KNEE","code_information":[{"code":"27598","type":"CPT"}],"standard_charges":[{"minimum":723.46,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.46,"methodology":"fee schedule"}]}]},{"description":"LEG SURGERY PROCEDURE","code_information":[{"code":"27599","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF LOWER LEG","code_information":[{"code":"27600","type":"CPT"}],"standard_charges":[{"minimum":420.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF LOWER LEG","code_information":[{"code":"27601","type":"CPT"}],"standard_charges":[{"minimum":467.76,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF LOWER LEG","code_information":[{"code":"27602","type":"CPT"}],"standard_charges":[{"minimum":496.73,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DRAIN LOWER LEG LESION","code_information":[{"code":"27603","type":"CPT"}],"standard_charges":[{"minimum":412.69,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DRAIN LOWER LEG BURSA","code_information":[{"code":"27604","type":"CPT"}],"standard_charges":[{"minimum":342.6,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF ACHILLES TENDON","code_information":[{"code":"27605","type":"CPT"}],"standard_charges":[{"minimum":193.83,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"INCISION OF ACHILLES TENDON","code_information":[{"code":"27606","type":"CPT"}],"standard_charges":[{"minimum":284.66,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG BONE LESION","code_information":[{"code":"27607","type":"CPT"}],"standard_charges":[{"minimum":634.41,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT ANKLE JOINT","code_information":[{"code":"27610","type":"CPT"}],"standard_charges":[{"minimum":683.76,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF ANKLE JOINT","code_information":[{"code":"27612","type":"CPT"}],"standard_charges":[{"minimum":607.59,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY LOWER LEG SOFT TISSUE","code_information":[{"code":"27613","type":"CPT"}],"standard_charges":[{"minimum":170.94,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY LOWER LEG SOFT TISSUE","code_information":[{"code":"27614","type":"CPT"}],"standard_charges":[{"minimum":441.3,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT LEG/ANKLE TUM < 5 CM","code_information":[{"code":"27615","type":"CPT"}],"standard_charges":[{"minimum":1064.27,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT LEG/ANKLE TUM 5 CM/>","code_information":[{"code":"27616","type":"CPT"}],"standard_charges":[{"minimum":1320.32,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1320.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1320.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1320.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC LEG/ANKLE TUM < 3 CM","code_information":[{"code":"27618","type":"CPT"}],"standard_charges":[{"minimum":325.07,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC LEG/ANKLE TUM DEEP <5 CM","code_information":[{"code":"27619","type":"CPT"}],"standard_charges":[{"minimum":499.23,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT ANKLE JOINT","code_information":[{"code":"27620","type":"CPT"}],"standard_charges":[{"minimum":477.06,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE ANKLE JOINT LINING","code_information":[{"code":"27625","type":"CPT"}],"standard_charges":[{"minimum":608.31,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE ANKLE JOINT LINING","code_information":[{"code":"27626","type":"CPT"}],"standard_charges":[{"minimum":656.94,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TENDON LESION","code_information":[{"code":"27630","type":"CPT"}],"standard_charges":[{"minimum":380.86,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXC LEG/ANKLE LES SC 3 CM/>","code_information":[{"code":"27632","type":"CPT"}],"standard_charges":[{"minimum":432,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC LEG/ANKLE TUM DEP 5 CM/>","code_information":[{"code":"27634","type":"CPT"}],"standard_charges":[{"minimum":709.87,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE LOWER LEG BONE LESION","code_information":[{"code":"27635","type":"CPT"}],"standard_charges":[{"minimum":615.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT LEG BONE LESION","code_information":[{"code":"27637","type":"CPT"}],"standard_charges":[{"minimum":791.41,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT LEG BONE LESION","code_information":[{"code":"27638","type":"CPT"}],"standard_charges":[{"minimum":785.68,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF TIBIA","code_information":[{"code":"27640","type":"CPT"}],"standard_charges":[{"minimum":878.66,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":878.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":878.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":878.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF FIBULA","code_information":[{"code":"27641","type":"CPT"}],"standard_charges":[{"minimum":690.92,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT TIBIA TUMOR","code_information":[{"code":"27645","type":"CPT"}],"standard_charges":[{"minimum":1848.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"}]}]},{"description":"RESECT FIBULA TUMOR","code_information":[{"code":"27646","type":"CPT"}],"standard_charges":[{"minimum":1608.2,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1608.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1608.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1608.2,"methodology":"fee schedule"}]}]},{"description":"RESECT TALUS/CALCANEUS TUM","code_information":[{"code":"27647","type":"CPT"}],"standard_charges":[{"minimum":1049.61,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR ANKLE X-RAY","code_information":[{"code":"27648","type":"CPT"}],"standard_charges":[{"minimum":53.64,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":368.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"}]}]},{"description":"REPAIR ACHILLES TENDON","code_information":[{"code":"27650","type":"CPT"}],"standard_charges":[{"minimum":697.35,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":697.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":697.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":697.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT ACHILLES TENDON","code_information":[{"code":"27652","type":"CPT"}],"standard_charges":[{"minimum":712.02,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ACHILLES TENDON","code_information":[{"code":"27654","type":"CPT"}],"standard_charges":[{"minimum":758.86,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR LEG FASCIA DEFECT","code_information":[{"code":"27656","type":"CPT"}],"standard_charges":[{"minimum":363.34,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LEG TENDON EACH","code_information":[{"code":"27658","type":"CPT"}],"standard_charges":[{"minimum":393.38,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LEG TENDON EACH","code_information":[{"code":"27659","type":"CPT"}],"standard_charges":[{"minimum":502.45,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LEG TENDON EACH","code_information":[{"code":"27664","type":"CPT"}],"standard_charges":[{"minimum":385.87,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LEG TENDON EACH","code_information":[{"code":"27665","type":"CPT"}],"standard_charges":[{"minimum":451.67,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR LOWER LEG TENDONS","code_information":[{"code":"27675","type":"CPT"}],"standard_charges":[{"minimum":526.77,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR LOWER LEG TENDONS","code_information":[{"code":"27676","type":"CPT"}],"standard_charges":[{"minimum":646.57,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF LOWER LEG TENDON","code_information":[{"code":"27680","type":"CPT"}],"standard_charges":[{"minimum":447.74,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF LOWER LEG TENDONS","code_information":[{"code":"27681","type":"CPT"}],"standard_charges":[{"minimum":539.64,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF LOWER LEG TENDON","code_information":[{"code":"27685","type":"CPT"}],"standard_charges":[{"minimum":496.01,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE LOWER LEG TENDONS","code_information":[{"code":"27686","type":"CPT"}],"standard_charges":[{"minimum":565.03,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CALF TENDON","code_information":[{"code":"27687","type":"CPT"}],"standard_charges":[{"minimum":483.14,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISE LOWER LEG TENDON","code_information":[{"code":"27690","type":"CPT"}],"standard_charges":[{"minimum":676.97,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE LOWER LEG TENDON","code_information":[{"code":"27691","type":"CPT"}],"standard_charges":[{"minimum":787.12,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISE ADDITIONAL LEG TENDON","code_information":[{"code":"27692","type":"CPT"}],"standard_charges":[{"minimum":105.85,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANKLE LIGAMENT","code_information":[{"code":"27695","type":"CPT"}],"standard_charges":[{"minimum":517.11,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANKLE LIGAMENTS","code_information":[{"code":"27696","type":"CPT"}],"standard_charges":[{"minimum":581.84,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANKLE LIGAMENT","code_information":[{"code":"27698","type":"CPT"}],"standard_charges":[{"minimum":675.54,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ANKLE JOINT","code_information":[{"code":"27700","type":"CPT"}],"standard_charges":[{"minimum":754.93,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT ANKLE JOINT","code_information":[{"code":"27702","type":"CPT"}],"standard_charges":[{"minimum":1014.2,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8501.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6376.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6376.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION ANKLE JOINT","code_information":[{"code":"27703","type":"CPT"}],"standard_charges":[{"minimum":1168.69,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8501.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6376.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6376.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1168.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1168.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1168.69,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ANKLE IMPLANT","code_information":[{"code":"27704","type":"CPT"}],"standard_charges":[{"minimum":601.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TIBIA","code_information":[{"code":"27705","type":"CPT"}],"standard_charges":[{"minimum":792.48,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF FIBULA","code_information":[{"code":"27707","type":"CPT"}],"standard_charges":[{"minimum":432.72,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TIBIA  FIBULA","code_information":[{"code":"27709","type":"CPT"}],"standard_charges":[{"minimum":1205.17,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1205.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1205.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1205.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REALIGNMENT OF LOWER LEG","code_information":[{"code":"27712","type":"CPT"}],"standard_charges":[{"minimum":1161.9,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.9,"methodology":"fee schedule"}]}]},{"description":"REVISION OF LOWER LEG","code_information":[{"code":"27715","type":"CPT"}],"standard_charges":[{"minimum":1129.71,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129.71,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF TIBIA","code_information":[{"code":"27720","type":"CPT"}],"standard_charges":[{"minimum":921.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT OF TIBIA","code_information":[{"code":"27722","type":"CPT"}],"standard_charges":[{"minimum":946.25,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT OF TIBIA","code_information":[{"code":"27724","type":"CPT"}],"standard_charges":[{"minimum":1316.03,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LOWER LEG","code_information":[{"code":"27725","type":"CPT"}],"standard_charges":[{"minimum":1281.34,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1281.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1281.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1281.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR FIBULA NONUNION","code_information":[{"code":"27726","type":"CPT"}],"standard_charges":[{"minimum":1007.05,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LOWER LEG","code_information":[{"code":"27727","type":"CPT"}],"standard_charges":[{"minimum":1095.74,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF TIBIA EPIPHYSIS","code_information":[{"code":"27730","type":"CPT"}],"standard_charges":[{"minimum":626.9,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF FIBULA EPIPHYSIS","code_information":[{"code":"27732","type":"CPT"}],"standard_charges":[{"minimum":486,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR LOWER LEG EPIPHYSES","code_information":[{"code":"27734","type":"CPT"}],"standard_charges":[{"minimum":699.5,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LEG EPIPHYSES","code_information":[{"code":"27740","type":"CPT"}],"standard_charges":[{"minimum":752.07,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LEG EPIPHYSES","code_information":[{"code":"27742","type":"CPT"}],"standard_charges":[{"minimum":824.31,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REINFORCE TIBIA","code_information":[{"code":"27745","type":"CPT"}],"standard_charges":[{"minimum":788.9,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27750","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27752","type":"CPT"}],"standard_charges":[{"minimum":526.41,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27756","type":"CPT"}],"standard_charges":[{"minimum":615.82,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27758","type":"CPT"}],"standard_charges":[{"minimum":947.33,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":947.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":947.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":947.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27759","type":"CPT"}],"standard_charges":[{"minimum":1050.68,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"CLTX MEDIAL ANKLE FX","code_information":[{"code":"27760","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"CLTX MED ANKLE FX W/MNPJ","code_information":[{"code":"27762","type":"CPT"}],"standard_charges":[{"minimum":476.35,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"OPTX MEDIAL ANKLE FX","code_information":[{"code":"27766","type":"CPT"}],"standard_charges":[{"minimum":643,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":643,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":643,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":643,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"CLTX POST ANKLE FX","code_information":[{"code":"27767","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"CLTX POST ANKLE FX W/MNPJ","code_information":[{"code":"27768","type":"CPT"}],"standard_charges":[{"minimum":483.86,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"OPTX POST ANKLE FX","code_information":[{"code":"27769","type":"CPT"}],"standard_charges":[{"minimum":769.23,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF FIBULA FRACTURE","code_information":[{"code":"27780","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF FIBULA FRACTURE","code_information":[{"code":"27781","type":"CPT"}],"standard_charges":[{"minimum":437.37,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF FIBULA FRACTURE","code_information":[{"code":"27784","type":"CPT"}],"standard_charges":[{"minimum":759.22,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27786","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27788","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27792","type":"CPT"}],"standard_charges":[{"minimum":684.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27808","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27810","type":"CPT"}],"standard_charges":[{"minimum":462.76,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27814","type":"CPT"}],"standard_charges":[{"minimum":809.29,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27816","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27818","type":"CPT"}],"standard_charges":[{"minimum":475.27,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27822","type":"CPT"}],"standard_charges":[{"minimum":924.08,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":924.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":924.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":924.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27823","type":"CPT"}],"standard_charges":[{"minimum":1040.31,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27824","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27825","type":"CPT"}],"standard_charges":[{"minimum":527.84,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27826","type":"CPT"}],"standard_charges":[{"minimum":903.7,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":903.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":903.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":903.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27827","type":"CPT"}],"standard_charges":[{"minimum":1182.28,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27828","type":"CPT"}],"standard_charges":[{"minimum":1397.21,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG JOINT","code_information":[{"code":"27829","type":"CPT"}],"standard_charges":[{"minimum":749.57,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG DISLOCATION","code_information":[{"code":"27830","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG DISLOCATION","code_information":[{"code":"27831","type":"CPT"}],"standard_charges":[{"minimum":440.94,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT LOWER LEG DISLOCATION","code_information":[{"code":"27832","type":"CPT"}],"standard_charges":[{"minimum":804.64,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT ANKLE DISLOCATION","code_information":[{"code":"27840","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT ANKLE DISLOCATION","code_information":[{"code":"27842","type":"CPT"}],"standard_charges":[{"minimum":527.13,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT ANKLE DISLOCATION","code_information":[{"code":"27846","type":"CPT"}],"standard_charges":[{"minimum":770.31,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT ANKLE DISLOCATION","code_information":[{"code":"27848","type":"CPT"}],"standard_charges":[{"minimum":834.68,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FIXATION OF ANKLE JOINT","code_information":[{"code":"27860","type":"CPT"}],"standard_charges":[{"minimum":173.44,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF ANKLE JOINT OPEN","code_information":[{"code":"27870","type":"CPT"}],"standard_charges":[{"minimum":1063.2,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8501.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6376.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6376.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1063.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1063.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1063.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"FUSION OF TIBIOFIBULAR JOINT","code_information":[{"code":"27871","type":"CPT"}],"standard_charges":[{"minimum":732.04,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF LOWER LEG","code_information":[{"code":"27880","type":"CPT"}],"standard_charges":[{"minimum":933.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF LOWER LEG","code_information":[{"code":"27881","type":"CPT"}],"standard_charges":[{"minimum":877.59,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.59,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF LOWER LEG","code_information":[{"code":"27882","type":"CPT"}],"standard_charges":[{"minimum":615.46,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.46,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"27884","type":"CPT"}],"standard_charges":[{"minimum":605.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"27886","type":"CPT"}],"standard_charges":[{"minimum":677.68,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.68,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF FOOT AT ANKLE","code_information":[{"code":"27888","type":"CPT"}],"standard_charges":[{"minimum":595.07,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF FOOT AT ANKLE","code_information":[{"code":"27889","type":"CPT"}],"standard_charges":[{"minimum":668.39,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF LEG","code_information":[{"code":"27892","type":"CPT"}],"standard_charges":[{"minimum":565.39,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF LEG","code_information":[{"code":"27893","type":"CPT"}],"standard_charges":[{"minimum":653.72,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF LEG","code_information":[{"code":"27894","type":"CPT"}],"standard_charges":[{"minimum":853.99,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":853.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":853.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":853.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"LEG/ANKLE SURGERY PROCEDURE","code_information":[{"code":"27899","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF BURSA OF FOOT","code_information":[{"code":"28001","type":"CPT"}],"standard_charges":[{"minimum":100.85,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF FOOT INFECTION","code_information":[{"code":"28002","type":"CPT"}],"standard_charges":[{"minimum":147.34,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF FOOT INFECTION","code_information":[{"code":"28003","type":"CPT"}],"standard_charges":[{"minimum":271.07,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT BONE LESION","code_information":[{"code":"28005","type":"CPT"}],"standard_charges":[{"minimum":605.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF FOOT FASCIA","code_information":[{"code":"28008","type":"CPT"}],"standard_charges":[{"minimum":312.91,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TOE TENDON","code_information":[{"code":"28010","type":"CPT"}],"standard_charges":[{"minimum":222.08,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TOE TENDONS","code_information":[{"code":"28011","type":"CPT"}],"standard_charges":[{"minimum":297.54,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF FOOT JOINT","code_information":[{"code":"28020","type":"CPT"}],"standard_charges":[{"minimum":388.01,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF FOOT JOINT","code_information":[{"code":"28022","type":"CPT"}],"standard_charges":[{"minimum":348.32,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF TOE JOINT","code_information":[{"code":"28024","type":"CPT"}],"standard_charges":[{"minimum":327.93,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSION OF TIBIA NERVE","code_information":[{"code":"28035","type":"CPT"}],"standard_charges":[{"minimum":380.86,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"EXC FOOT/TOE TUM SC 1.5 CM/>","code_information":[{"code":"28039","type":"CPT"}],"standard_charges":[{"minimum":359.05,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC FOOT/TOE TUM DEP 1.5CM/>","code_information":[{"code":"28041","type":"CPT"}],"standard_charges":[{"minimum":477.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXC FOOT/TOE TUM SC < 1.5 CM","code_information":[{"code":"28043","type":"CPT"}],"standard_charges":[{"minimum":277.51,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC FOOT/TOE TUM DEEP <1.5CM","code_information":[{"code":"28045","type":"CPT"}],"standard_charges":[{"minimum":368.7,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT FOOT/TOE TUMOR < 3 CM","code_information":[{"code":"28046","type":"CPT"}],"standard_charges":[{"minimum":738.84,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"RESECT FOOT/TOE TUMOR 3 CM/>","code_information":[{"code":"28047","type":"CPT"}],"standard_charges":[{"minimum":1088.94,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1088.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1088.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1088.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF FOOT JOINT LINING","code_information":[{"code":"28050","type":"CPT"}],"standard_charges":[{"minimum":297.18,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF FOOT JOINT LINING","code_information":[{"code":"28052","type":"CPT"}],"standard_charges":[{"minimum":272.5,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF TOE JOINT LINING","code_information":[{"code":"28054","type":"CPT"}],"standard_charges":[{"minimum":249.26,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"NEURECTOMY FOOT","code_information":[{"code":"28055","type":"CPT"}],"standard_charges":[{"minimum":413.05,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL FOOT FASCIA","code_information":[{"code":"28060","type":"CPT"}],"standard_charges":[{"minimum":383.01,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT FASCIA","code_information":[{"code":"28062","type":"CPT"}],"standard_charges":[{"minimum":429.5,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT JOINT LINING","code_information":[{"code":"28070","type":"CPT"}],"standard_charges":[{"minimum":364.41,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT JOINT LINING","code_information":[{"code":"28072","type":"CPT"}],"standard_charges":[{"minimum":346.17,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT LESION","code_information":[{"code":"28080","type":"CPT"}],"standard_charges":[{"minimum":402.68,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"EXCISE FOOT TENDON SHEATH","code_information":[{"code":"28086","type":"CPT"}],"standard_charges":[{"minimum":371.92,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"EXCISE FOOT TENDON SHEATH","code_information":[{"code":"28088","type":"CPT"}],"standard_charges":[{"minimum":312.91,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT LESION","code_information":[{"code":"28090","type":"CPT"}],"standard_charges":[{"minimum":328.29,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TOE LESIONS","code_information":[{"code":"28092","type":"CPT"}],"standard_charges":[{"minimum":290.39,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ANKLE/HEEL LESION","code_information":[{"code":"28100","type":"CPT"}],"standard_charges":[{"minimum":443.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT FOOT LESION","code_information":[{"code":"28102","type":"CPT"}],"standard_charges":[{"minimum":650.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT FOOT LESION","code_information":[{"code":"28103","type":"CPT"}],"standard_charges":[{"minimum":411.26,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT LESION","code_information":[{"code":"28104","type":"CPT"}],"standard_charges":[{"minimum":376.93,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT FOOT LESION","code_information":[{"code":"28106","type":"CPT"}],"standard_charges":[{"minimum":452.03,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE/GRAFT FOOT LESION","code_information":[{"code":"28107","type":"CPT"}],"standard_charges":[{"minimum":367.99,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TOE LESIONS","code_information":[{"code":"28108","type":"CPT"}],"standard_charges":[{"minimum":307.19,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"PART REMOVAL OF METATARSAL","code_information":[{"code":"28110","type":"CPT"}],"standard_charges":[{"minimum":312.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PART REMOVAL OF METATARSAL","code_information":[{"code":"28111","type":"CPT"}],"standard_charges":[{"minimum":338.31,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PART REMOVAL OF METATARSAL","code_information":[{"code":"28112","type":"CPT"}],"standard_charges":[{"minimum":332.94,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PART REMOVAL OF METATARSAL","code_information":[{"code":"28113","type":"CPT"}],"standard_charges":[{"minimum":453.82,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF METATARSAL HEADS","code_information":[{"code":"28114","type":"CPT"}],"standard_charges":[{"minimum":886.17,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF FOOT","code_information":[{"code":"28116","type":"CPT"}],"standard_charges":[{"minimum":616.89,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HEEL BONE","code_information":[{"code":"28118","type":"CPT"}],"standard_charges":[{"minimum":448.81,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HEEL SPUR","code_information":[{"code":"28119","type":"CPT"}],"standard_charges":[{"minimum":387.66,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PART REMOVAL OF ANKLE/HEEL","code_information":[{"code":"28120","type":"CPT"}],"standard_charges":[{"minimum":525.7,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF FOOT BONE","code_information":[{"code":"28122","type":"CPT"}],"standard_charges":[{"minimum":466.69,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF TOE","code_information":[{"code":"28124","type":"CPT"}],"standard_charges":[{"minimum":356.19,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF TOE","code_information":[{"code":"28126","type":"CPT"}],"standard_charges":[{"minimum":266.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ANKLE BONE","code_information":[{"code":"28130","type":"CPT"}],"standard_charges":[{"minimum":655.87,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF METATARSAL","code_information":[{"code":"28140","type":"CPT"}],"standard_charges":[{"minimum":449.88,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TOE","code_information":[{"code":"28150","type":"CPT"}],"standard_charges":[{"minimum":297.18,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF TOE","code_information":[{"code":"28153","type":"CPT"}],"standard_charges":[{"minimum":281.09,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF TOE","code_information":[{"code":"28160","type":"CPT"}],"standard_charges":[{"minimum":284.31,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT TARSAL TUMOR","code_information":[{"code":"28171","type":"CPT"}],"standard_charges":[{"minimum":1164.04,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT METATARSAL TUMOR","code_information":[{"code":"28173","type":"CPT"}],"standard_charges":[{"minimum":766.02,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT PHALANX OF TOE TUMOR","code_information":[{"code":"28175","type":"CPT"}],"standard_charges":[{"minimum":497.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT FOREIGN BODY","code_information":[{"code":"28190","type":"CPT"}],"standard_charges":[{"minimum":140.54,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT FOREIGN BODY","code_information":[{"code":"28192","type":"CPT"}],"standard_charges":[{"minimum":329.37,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOOT FOREIGN BODY","code_information":[{"code":"28193","type":"CPT"}],"standard_charges":[{"minimum":388.01,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF FOOT TENDON","code_information":[{"code":"28200","type":"CPT"}],"standard_charges":[{"minimum":347.6,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT OF FOOT TENDON","code_information":[{"code":"28202","type":"CPT"}],"standard_charges":[{"minimum":454.53,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF FOOT TENDON","code_information":[{"code":"28208","type":"CPT"}],"standard_charges":[{"minimum":341.52,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT OF FOOT TENDON","code_information":[{"code":"28210","type":"CPT"}],"standard_charges":[{"minimum":450.24,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF FOOT TENDON","code_information":[{"code":"28220","type":"CPT"}],"standard_charges":[{"minimum":325.07,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF FOOT TENDONS","code_information":[{"code":"28222","type":"CPT"}],"standard_charges":[{"minimum":393.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF FOOT TENDON","code_information":[{"code":"28225","type":"CPT"}],"standard_charges":[{"minimum":282.16,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF FOOT TENDONS","code_information":[{"code":"28226","type":"CPT"}],"standard_charges":[{"minimum":425.92,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF FOOT TENDON(S)","code_information":[{"code":"28230","type":"CPT"}],"standard_charges":[{"minimum":302.9,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TOE TENDON","code_information":[{"code":"28232","type":"CPT"}],"standard_charges":[{"minimum":257.13,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"INCISION OF FOOT TENDON","code_information":[{"code":"28234","type":"CPT"}],"standard_charges":[{"minimum":287.52,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REVISION OF FOOT TENDON","code_information":[{"code":"28238","type":"CPT"}],"standard_charges":[{"minimum":518.9,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF BIG TOE","code_information":[{"code":"28240","type":"CPT"}],"standard_charges":[{"minimum":312.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF FOOT FASCIA","code_information":[{"code":"28250","type":"CPT"}],"standard_charges":[{"minimum":437.72,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF MIDFOOT JOINT","code_information":[{"code":"28260","type":"CPT"}],"standard_charges":[{"minimum":572.9,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF FOOT TENDON","code_information":[{"code":"28261","type":"CPT"}],"standard_charges":[{"minimum":890.82,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REVISION OF FOOT AND ANKLE","code_information":[{"code":"28262","type":"CPT"}],"standard_charges":[{"minimum":1166.55,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF MIDFOOT JOINT","code_information":[{"code":"28264","type":"CPT"}],"standard_charges":[{"minimum":708.8,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF FOOT CONTRACTURE","code_information":[{"code":"28270","type":"CPT"}],"standard_charges":[{"minimum":355.47,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF TOE JOINT EACH","code_information":[{"code":"28272","type":"CPT"}],"standard_charges":[{"minimum":267.5,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"FUSION OF TOES","code_information":[{"code":"28280","type":"CPT"}],"standard_charges":[{"minimum":366.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HAMMERTOE","code_information":[{"code":"28285","type":"CPT"}],"standard_charges":[{"minimum":411.62,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HAMMERTOE","code_information":[{"code":"28286","type":"CPT"}],"standard_charges":[{"minimum":316.85,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF FOOT BONE","code_information":[{"code":"28288","type":"CPT"}],"standard_charges":[{"minimum":463.11,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CORRJ HALUX RIGDUS W/O IMPLT","code_information":[{"code":"28289","type":"CPT"}],"standard_charges":[{"minimum":490.29,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CORRJ HALUX RIGDUS W/IMPLT","code_information":[{"code":"28291","type":"CPT"}],"standard_charges":[{"minimum":510.32,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":510.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":510.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":510.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28292","type":"CPT"}],"standard_charges":[{"minimum":516.76,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28295","type":"CPT"}],"standard_charges":[{"minimum":637.99,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28296","type":"CPT"}],"standard_charges":[{"minimum":545.37,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28297","type":"CPT"}],"standard_charges":[{"minimum":637.63,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28298","type":"CPT"}],"standard_charges":[{"minimum":539.29,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28299","type":"CPT"}],"standard_charges":[{"minimum":631.55,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HEEL BONE","code_information":[{"code":"28300","type":"CPT"}],"standard_charges":[{"minimum":688.77,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":688.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":688.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":688.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF ANKLE BONE","code_information":[{"code":"28302","type":"CPT"}],"standard_charges":[{"minimum":759.58,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF MIDFOOT BONES","code_information":[{"code":"28304","type":"CPT"}],"standard_charges":[{"minimum":650.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISE/GRAFT MIDFOOT BONES","code_information":[{"code":"28305","type":"CPT"}],"standard_charges":[{"minimum":714.52,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF METATARSAL","code_information":[{"code":"28306","type":"CPT"}],"standard_charges":[{"minimum":432.72,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF METATARSAL","code_information":[{"code":"28307","type":"CPT"}],"standard_charges":[{"minimum":550.73,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"INCISION OF METATARSAL","code_information":[{"code":"28308","type":"CPT"}],"standard_charges":[{"minimum":412.69,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"INCISION OF METATARSALS","code_information":[{"code":"28309","type":"CPT"}],"standard_charges":[{"minimum":956.27,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF BIG TOE","code_information":[{"code":"28310","type":"CPT"}],"standard_charges":[{"minimum":386.94,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF TOE","code_information":[{"code":"28312","type":"CPT"}],"standard_charges":[{"minimum":366.92,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFORMITY OF TOE","code_information":[{"code":"28313","type":"CPT"}],"standard_charges":[{"minimum":384.44,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SESAMOID BONE","code_information":[{"code":"28315","type":"CPT"}],"standard_charges":[{"minimum":346.53,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF FOOT BONES","code_information":[{"code":"28320","type":"CPT"}],"standard_charges":[{"minimum":653.37,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF METATARSALS","code_information":[{"code":"28322","type":"CPT"}],"standard_charges":[{"minimum":613.31,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RESECT ENLARGED TOE TISSUE","code_information":[{"code":"28340","type":"CPT"}],"standard_charges":[{"minimum":433.43,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"RESECT ENLARGED TOE","code_information":[{"code":"28341","type":"CPT"}],"standard_charges":[{"minimum":515.33,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR EXTRA TOE(S)","code_information":[{"code":"28344","type":"CPT"}],"standard_charges":[{"minimum":297.54,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR WEBBED TOE(S)","code_information":[{"code":"28345","type":"CPT"}],"standard_charges":[{"minimum":384.8,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CLEFT FOOT","code_information":[{"code":"28360","type":"CPT"}],"standard_charges":[{"minimum":1160.11,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF HEEL FRACTURE","code_information":[{"code":"28400","type":"CPT"}],"standard_charges":[{"minimum":249.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF HEEL FRACTURE","code_information":[{"code":"28405","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF HEEL FRACTURE","code_information":[{"code":"28406","type":"CPT"}],"standard_charges":[{"minimum":630.12,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT HEEL FRACTURE","code_information":[{"code":"28415","type":"CPT"}],"standard_charges":[{"minimum":1183.71,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT/GRAFT HEEL FRACTURE","code_information":[{"code":"28420","type":"CPT"}],"standard_charges":[{"minimum":1366.81,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"28430","type":"CPT"}],"standard_charges":[{"minimum":228.87,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"28435","type":"CPT"}],"standard_charges":[{"minimum":355.83,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"28436","type":"CPT"}],"standard_charges":[{"minimum":531.42,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT ANKLE FRACTURE","code_information":[{"code":"28445","type":"CPT"}],"standard_charges":[{"minimum":1107.54,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1107.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1107.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1107.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"OSTEOCHONDRAL TALUS AUTOGRFT","code_information":[{"code":"28446","type":"CPT"}],"standard_charges":[{"minimum":1289.57,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT MIDFOOT FRACTURE EACH","code_information":[{"code":"28450","type":"CPT"}],"standard_charges":[{"minimum":207.78,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT MIDFOOT FRACTURE EACH","code_information":[{"code":"28455","type":"CPT"}],"standard_charges":[{"minimum":246.76,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT MIDFOOT FRACTURE","code_information":[{"code":"28456","type":"CPT"}],"standard_charges":[{"minimum":397.67,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT MIDFOOT FRACTURE EACH","code_information":[{"code":"28465","type":"CPT"}],"standard_charges":[{"minimum":681.62,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT METATARSAL FRACTURE","code_information":[{"code":"28470","type":"CPT"}],"standard_charges":[{"minimum":223.15,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT METATARSAL FRACTURE","code_information":[{"code":"28475","type":"CPT"}],"standard_charges":[{"minimum":247.83,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT METATARSAL FRACTURE","code_information":[{"code":"28476","type":"CPT"}],"standard_charges":[{"minimum":414.12,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT METATARSAL FRACTURE","code_information":[{"code":"28485","type":"CPT"}],"standard_charges":[{"minimum":600.08,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT BIG TOE FRACTURE","code_information":[{"code":"28490","type":"CPT"}],"standard_charges":[{"minimum":135.18,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT BIG TOE FRACTURE","code_information":[{"code":"28495","type":"CPT"}],"standard_charges":[{"minimum":161.64,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT BIG TOE FRACTURE","code_information":[{"code":"28496","type":"CPT"}],"standard_charges":[{"minimum":293.96,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT BIG TOE FRACTURE","code_information":[{"code":"28505","type":"CPT"}],"standard_charges":[{"minimum":527.49,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF TOE FRACTURE","code_information":[{"code":"28510","type":"CPT"}],"standard_charges":[{"minimum":131.25,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF TOE FRACTURE","code_information":[{"code":"28515","type":"CPT"}],"standard_charges":[{"minimum":155.92,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT TOE FRACTURE","code_information":[{"code":"28525","type":"CPT"}],"standard_charges":[{"minimum":434.15,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT SESAMOID BONE FRACTURE","code_information":[{"code":"28530","type":"CPT"}],"standard_charges":[{"minimum":110.5,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT SESAMOID BONE FRACTURE","code_information":[{"code":"28531","type":"CPT"}],"standard_charges":[{"minimum":193.83,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28540","type":"CPT"}],"standard_charges":[{"minimum":190.61,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28545","type":"CPT"}],"standard_charges":[{"minimum":294.32,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28546","type":"CPT"}],"standard_charges":[{"minimum":379.43,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOOT DISLOCATION","code_information":[{"code":"28555","type":"CPT"}],"standard_charges":[{"minimum":702.36,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28570","type":"CPT"}],"standard_charges":[{"minimum":214.93,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1605.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1204.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28575","type":"CPT"}],"standard_charges":[{"minimum":367.63,"maximum":3561.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28576","type":"CPT"}],"standard_charges":[{"minimum":416.98,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOOT DISLOCATION","code_information":[{"code":"28585","type":"CPT"}],"standard_charges":[{"minimum":750.64,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28600","type":"CPT"}],"standard_charges":[{"minimum":173.8,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28605","type":"CPT"}],"standard_charges":[{"minimum":255.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28606","type":"CPT"}],"standard_charges":[{"minimum":419.13,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR FOOT DISLOCATION","code_information":[{"code":"28615","type":"CPT"}],"standard_charges":[{"minimum":878.31,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":878.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":878.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":878.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28630","type":"CPT"}],"standard_charges":[{"minimum":118.01,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28635","type":"CPT"}],"standard_charges":[{"minimum":139.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28636","type":"CPT"}],"standard_charges":[{"minimum":237.1,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR TOE DISLOCATION","code_information":[{"code":"28645","type":"CPT"}],"standard_charges":[{"minimum":517.83,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28660","type":"CPT"}],"standard_charges":[{"minimum":100.49,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28665","type":"CPT"}],"standard_charges":[{"minimum":134.82,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28666","type":"CPT"}],"standard_charges":[{"minimum":186.32,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF TOE DISLOCATION","code_information":[{"code":"28675","type":"CPT"}],"standard_charges":[{"minimum":440.94,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28705","type":"CPT"}],"standard_charges":[{"minimum":1285.28,"maximum":20188.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19796.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20188.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19992.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20090.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19600.48,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28715","type":"CPT"}],"standard_charges":[{"minimum":992.03,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28725","type":"CPT"}],"standard_charges":[{"minimum":823.59,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28730","type":"CPT"}],"standard_charges":[{"minimum":767.45,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28735","type":"CPT"}],"standard_charges":[{"minimum":820.37,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF FOOT BONES","code_information":[{"code":"28737","type":"CPT"}],"standard_charges":[{"minimum":731.68,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28740","type":"CPT"}],"standard_charges":[{"minimum":653.01,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF BIG TOE JOINT","code_information":[{"code":"28750","type":"CPT"}],"standard_charges":[{"minimum":610.45,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF BIG TOE JOINT","code_information":[{"code":"28755","type":"CPT"}],"standard_charges":[{"minimum":355.83,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"FUSION OF BIG TOE JOINT","code_information":[{"code":"28760","type":"CPT"}],"standard_charges":[{"minimum":607.23,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF MIDFOOT","code_information":[{"code":"28800","type":"CPT"}],"standard_charges":[{"minimum":557.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION THRU METATARSAL","code_information":[{"code":"28805","type":"CPT"}],"standard_charges":[{"minimum":742.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION TOE  METATARSAL","code_information":[{"code":"28810","type":"CPT"}],"standard_charges":[{"minimum":445.95,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF TOE","code_information":[{"code":"28820","type":"CPT"}],"standard_charges":[{"minimum":186.32,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL AMPUTATION OF TOE","code_information":[{"code":"28825","type":"CPT"}],"standard_charges":[{"minimum":181.67,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"HI ENRGY ESWT PLANTAR FASCIA","code_information":[{"code":"28890","type":"CPT"}],"standard_charges":[{"minimum":237.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"FOOT/TOES SURGERY PROCEDURE","code_information":[{"code":"28899","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1836.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1377.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1377.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29000","type":"CPT"}],"standard_charges":[{"minimum":208.85,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29010","type":"CPT"}],"standard_charges":[{"minimum":168.8,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29015","type":"CPT"}],"standard_charges":[{"minimum":189.54,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29035","type":"CPT"}],"standard_charges":[{"minimum":151.63,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29040","type":"CPT"}],"standard_charges":[{"minimum":182.38,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29044","type":"CPT"}],"standard_charges":[{"minimum":168.18,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29046","type":"CPT"}],"standard_charges":[{"minimum":197.76,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF FIGURE EIGHT","code_information":[{"code":"29049","type":"CPT"}],"standard_charges":[{"minimum":73.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF SHOULDER CAST","code_information":[{"code":"29055","type":"CPT"}],"standard_charges":[{"minimum":145.19,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF SHOULDER CAST","code_information":[{"code":"29058","type":"CPT"}],"standard_charges":[{"minimum":98.34,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF LONG ARM CAST","code_information":[{"code":"29065","type":"CPT"}],"standard_charges":[{"minimum":71.88,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF FOREARM CAST","code_information":[{"code":"29075","type":"CPT"}],"standard_charges":[{"minimum":65.8,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLY HAND/WRIST CAST","code_information":[{"code":"29085","type":"CPT"}],"standard_charges":[{"minimum":71.17,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPLY FINGER CAST","code_information":[{"code":"29086","type":"CPT"}],"standard_charges":[{"minimum":52.21,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPLY LONG ARM SPLINT","code_information":[{"code":"29105","type":"CPT"}],"standard_charges":[{"minimum":43.63,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPLY FOREARM SPLINT","code_information":[{"code":"29125","type":"CPT"}],"standard_charges":[{"minimum":42.56,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"APPLY FOREARM SPLINT","code_information":[{"code":"29126","type":"CPT"}],"standard_charges":[{"minimum":52.21,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF FINGER SPLINT","code_information":[{"code":"29130","type":"CPT"}],"standard_charges":[{"minimum":30.4,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF FINGER SPLINT","code_information":[{"code":"29131","type":"CPT"}],"standard_charges":[{"minimum":36.48,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"STRAPPING OF CHEST","code_information":[{"code":"29200","type":"CPT"}],"standard_charges":[{"minimum":18.95,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"STRAPPING OF SHOULDER","code_information":[{"code":"29240","type":"CPT"}],"standard_charges":[{"minimum":18.6,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"STRAPPING OF ELBOW OR WRIST","code_information":[{"code":"29260","type":"CPT"}],"standard_charges":[{"minimum":19.67,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"STRAPPING OF HAND OR FINGER","code_information":[{"code":"29280","type":"CPT"}],"standard_charges":[{"minimum":21.1,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF HIP CAST","code_information":[{"code":"29305","type":"CPT"}],"standard_charges":[{"minimum":166.65,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF HIP CASTS","code_information":[{"code":"29325","type":"CPT"}],"standard_charges":[{"minimum":186.68,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF LONG LEG CAST","code_information":[{"code":"29345","type":"CPT"}],"standard_charges":[{"minimum":104.07,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF LONG LEG CAST","code_information":[{"code":"29355","type":"CPT"}],"standard_charges":[{"minimum":111.58,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLY LONG LEG CAST BRACE","code_information":[{"code":"29358","type":"CPT"}],"standard_charges":[{"minimum":108.36,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF LONG LEG CAST","code_information":[{"code":"29365","type":"CPT"}],"standard_charges":[{"minimum":92.27,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLY SHORT LEG CAST","code_information":[{"code":"29405","type":"CPT"}],"standard_charges":[{"minimum":61.87,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLY SHORT LEG CAST","code_information":[{"code":"29425","type":"CPT"}],"standard_charges":[{"minimum":57.22,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLY SHORT LEG CAST","code_information":[{"code":"29435","type":"CPT"}],"standard_charges":[{"minimum":91.19,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"ADDITION OF WALKER TO CAST","code_information":[{"code":"29440","type":"CPT"}],"standard_charges":[{"minimum":29.68,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPLY RIGID LEG CAST","code_information":[{"code":"29445","type":"CPT"}],"standard_charges":[{"minimum":103.71,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF LEG CAST","code_information":[{"code":"29450","type":"CPT"}],"standard_charges":[{"minimum":118.37,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPLICATION LONG LEG SPLINT","code_information":[{"code":"29505","type":"CPT"}],"standard_charges":[{"minimum":55.07,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPLICATION LOWER LEG SPLINT","code_information":[{"code":"29515","type":"CPT"}],"standard_charges":[{"minimum":52.57,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"STRAPPING OF HIP","code_information":[{"code":"29520","type":"CPT"}],"standard_charges":[{"minimum":18.95,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"STRAPPING OF KNEE","code_information":[{"code":"29530","type":"CPT"}],"standard_charges":[{"minimum":18.6,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"STRAPPING OF ANKLE AND/OR FT","code_information":[{"code":"29540","type":"CPT"}],"standard_charges":[{"minimum":17.88,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"STRAPPING OF TOES","code_information":[{"code":"29550","type":"CPT"}],"standard_charges":[{"minimum":11.8,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF PASTE BOOT","code_information":[{"code":"29580","type":"CPT"}],"standard_charges":[{"minimum":27.54,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPLY MULTLAY COMPRS LWR LEG","code_information":[{"code":"29581","type":"CPT"}],"standard_charges":[{"minimum":27.89,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"APPL MULTLAY COMPRS ARM/HAND","code_information":[{"code":"29584","type":"CPT"}],"standard_charges":[{"minimum":16.45,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"REMOVAL/REVISION OF CAST","code_information":[{"code":"29700","type":"CPT"}],"standard_charges":[{"minimum":34.69,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"REMOVAL/REVISION OF CAST","code_information":[{"code":"29705","type":"CPT"}],"standard_charges":[{"minimum":46.49,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"REMOVAL/REVISION OF CAST","code_information":[{"code":"29710","type":"CPT"}],"standard_charges":[{"minimum":85.83,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":476.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF BODY CAST","code_information":[{"code":"29720","type":"CPT"}],"standard_charges":[{"minimum":45.77,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"WINDOWING OF CAST","code_information":[{"code":"29730","type":"CPT"}],"standard_charges":[{"minimum":46.85,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"WEDGING OF CAST","code_information":[{"code":"29740","type":"CPT"}],"standard_charges":[{"minimum":71.88,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"WEDGING OF CLUBFOOT CAST","code_information":[{"code":"29750","type":"CPT"}],"standard_charges":[{"minimum":80.11,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":290.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"}]}]},{"description":"CASTING/STRAPPING PROCEDURE","code_information":[{"code":"29799","type":"CPT"}],"standard_charges":[{"minimum":104.92,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":171.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.18,"methodology":"fee schedule"}]}]},{"description":"JAW ARTHROSCOPY/SURGERY","code_information":[{"code":"29800","type":"CPT"}],"standard_charges":[{"minimum":565.03,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"JAW ARTHROSCOPY/SURGERY","code_information":[{"code":"29804","type":"CPT"}],"standard_charges":[{"minimum":626.9,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS DX +- SYNOVIAL BX","code_information":[{"code":"29805","type":"CPT"}],"standard_charges":[{"minimum":497.45,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG CAPSULORPAPHY","code_information":[{"code":"29806","type":"CPT"}],"standard_charges":[{"minimum":1116.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG RPR SLAP LES","code_information":[{"code":"29807","type":"CPT"}],"standard_charges":[{"minimum":1090.73,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG RMVL LOOSE/FB","code_information":[{"code":"29819","type":"CPT"}],"standard_charges":[{"minimum":623.33,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG PRTL SYNVCT","code_information":[{"code":"29820","type":"CPT"}],"standard_charges":[{"minimum":566.47,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG COMPL SYNVCT","code_information":[{"code":"29821","type":"CPT"}],"standard_charges":[{"minimum":629.05,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG LMTD DBRDMT","code_information":[{"code":"29822","type":"CPT"}],"standard_charges":[{"minimum":575.41,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG XTNSV DBRDMT","code_information":[{"code":"29823","type":"CPT"}],"standard_charges":[{"minimum":629.41,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG DSTL CLAVICLC","code_information":[{"code":"29824","type":"CPT"}],"standard_charges":[{"minimum":718.45,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG LSSRESCJ ADS","code_information":[{"code":"29825","type":"CPT"}],"standard_charges":[{"minimum":622.25,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SHO ARTHRS SRG DECOMPRESSION","code_information":[{"code":"29826","type":"CPT"}],"standard_charges":[{"minimum":178.09,"maximum":9595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"}]}]},{"description":"ARTHROSCOP ROTATOR CUFF REPR","code_information":[{"code":"29827","type":"CPT"}],"standard_charges":[{"minimum":1125.42,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"ARTHROSCOPY BICEPS TENODESIS","code_information":[{"code":"29828","type":"CPT"}],"standard_charges":[{"minimum":966.64,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"ELBOW ARTHROSCOPY","code_information":[{"code":"29830","type":"CPT"}],"standard_charges":[{"minimum":486.36,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29834","type":"CPT"}],"standard_charges":[{"minimum":522.84,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29835","type":"CPT"}],"standard_charges":[{"minimum":542.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29836","type":"CPT"}],"standard_charges":[{"minimum":620.82,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29837","type":"CPT"}],"standard_charges":[{"minimum":558.24,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29838","type":"CPT"}],"standard_charges":[{"minimum":632.62,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":632.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":632.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":632.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"WRIST ARTHROSCOPY","code_information":[{"code":"29840","type":"CPT"}],"standard_charges":[{"minimum":480.64,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29843","type":"CPT"}],"standard_charges":[{"minimum":519.26,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29844","type":"CPT"}],"standard_charges":[{"minimum":531.42,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29845","type":"CPT"}],"standard_charges":[{"minimum":623.68,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29846","type":"CPT"}],"standard_charges":[{"minimum":556.45,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29847","type":"CPT"}],"standard_charges":[{"minimum":578.98,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"WRIST ENDOSCOPY/SURGERY","code_information":[{"code":"29848","type":"CPT"}],"standard_charges":[{"minimum":547.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29850","type":"CPT"}],"standard_charges":[{"minimum":663.38,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29851","type":"CPT"}],"standard_charges":[{"minimum":981.3,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"TIBIAL ARTHROSCOPY/SURGERY","code_information":[{"code":"29855","type":"CPT"}],"standard_charges":[{"minimum":825.38,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"TIBIAL ARTHROSCOPY/SURGERY","code_information":[{"code":"29856","type":"CPT"}],"standard_charges":[{"minimum":1046.39,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"HIP ARTHROSCOPY DX","code_information":[{"code":"29860","type":"CPT"}],"standard_charges":[{"minimum":695.21,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":695.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":695.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":695.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"HIP ARTHRO W/FB REMOVAL","code_information":[{"code":"29861","type":"CPT"}],"standard_charges":[{"minimum":755.64,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":755.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":755.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":755.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"HIP ARTHR0 W/DEBRIDEMENT","code_information":[{"code":"29862","type":"CPT"}],"standard_charges":[{"minimum":862.57,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"HIP ARTHR0 W/SYNOVECTOMY","code_information":[{"code":"29863","type":"CPT"}],"standard_charges":[{"minimum":861.86,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"AUTGRFT IMPLNT KNEE W/SCOPE","code_information":[{"code":"29866","type":"CPT"}],"standard_charges":[{"minimum":1111.12,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1111.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1111.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1111.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"ALLGRFT IMPLNT KNEE W/SCOPE","code_information":[{"code":"29867","type":"CPT"}],"standard_charges":[{"minimum":1346.79,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"MENISCAL TRNSPL KNEE W/SCPE","code_information":[{"code":"29868","type":"CPT"}],"standard_charges":[{"minimum":1750.18,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1750.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1750.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1750.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY DX","code_information":[{"code":"29870","type":"CPT"}],"standard_charges":[{"minimum":437.37,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/DRAINAGE","code_information":[{"code":"29871","type":"CPT"}],"standard_charges":[{"minimum":548.23,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29873","type":"CPT"}],"standard_charges":[{"minimum":573.26,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":573.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":573.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":573.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29874","type":"CPT"}],"standard_charges":[{"minimum":571.83,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":571.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":571.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":571.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29875","type":"CPT"}],"standard_charges":[{"minimum":528.56,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29876","type":"CPT"}],"standard_charges":[{"minimum":692.35,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29877","type":"CPT"}],"standard_charges":[{"minimum":658.73,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29879","type":"CPT"}],"standard_charges":[{"minimum":701.64,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29880","type":"CPT"}],"standard_charges":[{"minimum":597.22,"maximum":9595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29881","type":"CPT"}],"standard_charges":[{"minimum":575.41,"maximum":9595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29882","type":"CPT"}],"standard_charges":[{"minimum":729.18,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29883","type":"CPT"}],"standard_charges":[{"minimum":891.18,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29884","type":"CPT"}],"standard_charges":[{"minimum":657.66,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29885","type":"CPT"}],"standard_charges":[{"minimum":801.78,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29886","type":"CPT"}],"standard_charges":[{"minimum":676.61,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29887","type":"CPT"}],"standard_charges":[{"minimum":799.27,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29888","type":"CPT"}],"standard_charges":[{"minimum":1026.72,"maximum":9595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7146,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29889","type":"CPT"}],"standard_charges":[{"minimum":1291.35,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1291.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1291.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1291.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29891","type":"CPT"}],"standard_charges":[{"minimum":714.52,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29892","type":"CPT"}],"standard_charges":[{"minimum":680.55,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SCOPE PLANTAR FASCIOTOMY","code_information":[{"code":"29893","type":"CPT"}],"standard_charges":[{"minimum":466.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29894","type":"CPT"}],"standard_charges":[{"minimum":535,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":535,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":535,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":535,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29895","type":"CPT"}],"standard_charges":[{"minimum":491.01,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29897","type":"CPT"}],"standard_charges":[{"minimum":525.34,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29898","type":"CPT"}],"standard_charges":[{"minimum":593.64,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":593.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29899","type":"CPT"}],"standard_charges":[{"minimum":1058.9,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"MCP JOINT ARTHROSCOPY DX","code_information":[{"code":"29900","type":"CPT"}],"standard_charges":[{"minimum":539.29,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"MCP JOINT ARTHROSCOPY SURG","code_information":[{"code":"29901","type":"CPT"}],"standard_charges":[{"minimum":577.55,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"MCP JOINT ARTHROSCOPY SURG","code_information":[{"code":"29902","type":"CPT"}],"standard_charges":[{"minimum":611.88,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1722.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1756.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1739.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.75,"methodology":"fee schedule"}]}]},{"description":"SUBTALAR ARTHRO W/FB RMVL","code_information":[{"code":"29904","type":"CPT"}],"standard_charges":[{"minimum":679.11,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":679.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":679.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":679.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SUBTALAR ARTHRO W/EXC","code_information":[{"code":"29905","type":"CPT"}],"standard_charges":[{"minimum":546.08,"maximum":7842.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SUBTALAR ARTHRO W/DEB","code_information":[{"code":"29906","type":"CPT"}],"standard_charges":[{"minimum":692.35,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SUBTALAR ARTHRO W/FUSION","code_information":[{"code":"29907","type":"CPT"}],"standard_charges":[{"minimum":928.02,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"HIP ARTHRO W/FEMOROPLASTY","code_information":[{"code":"29914","type":"CPT"}],"standard_charges":[{"minimum":1046.39,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"HIP ARTHRO ACETABULOPLASTY","code_information":[{"code":"29915","type":"CPT"}],"standard_charges":[{"minimum":1072.14,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"HIP ARTHRO W/LABRAL REPAIR","code_information":[{"code":"29916","type":"CPT"}],"standard_charges":[{"minimum":1067.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1067.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1067.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1067.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"ARTHROSCOPY OF JOINT","code_information":[{"code":"29999","type":"CPT"}],"standard_charges":[{"minimum":153.23,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":258.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":263.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":262.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":255.67,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF NOSE LESION","code_information":[{"code":"30000","type":"CPT"}],"standard_charges":[{"minimum":128.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF NOSE LESION","code_information":[{"code":"30020","type":"CPT"}],"standard_charges":[{"minimum":130.17,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"INTRANASAL BIOPSY","code_information":[{"code":"30100","type":"CPT"}],"standard_charges":[{"minimum":72.24,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NOSE POLYP(S)","code_information":[{"code":"30110","type":"CPT"}],"standard_charges":[{"minimum":140.9,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NOSE POLYP(S)","code_information":[{"code":"30115","type":"CPT"}],"standard_charges":[{"minimum":493.15,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF INTRANASAL LESION","code_information":[{"code":"30117","type":"CPT"}],"standard_charges":[{"minimum":437.01,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF INTRANASAL LESION","code_information":[{"code":"30118","type":"CPT"}],"standard_charges":[{"minimum":749.57,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30120","type":"CPT"}],"standard_charges":[{"minimum":443.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NOSE LESION","code_information":[{"code":"30124","type":"CPT"}],"standard_charges":[{"minimum":323.29,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NOSE LESION","code_information":[{"code":"30125","type":"CPT"}],"standard_charges":[{"minimum":692.7,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE INFERIOR TURBINATE","code_information":[{"code":"30130","type":"CPT"}],"standard_charges":[{"minimum":440.23,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"RESECT INFERIOR TURBINATE","code_information":[{"code":"30140","type":"CPT"}],"standard_charges":[{"minimum":186.68,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF NOSE","code_information":[{"code":"30150","type":"CPT"}],"standard_charges":[{"minimum":844.33,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NOSE","code_information":[{"code":"30160","type":"CPT"}],"standard_charges":[{"minimum":861.86,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NOSE","code_information":[{"code":"30200","type":"CPT"}],"standard_charges":[{"minimum":62.94,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"NASAL SINUS THERAPY","code_information":[{"code":"30210","type":"CPT"}],"standard_charges":[{"minimum":109.07,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1967.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1475.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1475.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"INSERT NASAL SEPTAL BUTTON","code_information":[{"code":"30220","type":"CPT"}],"standard_charges":[{"minimum":135.89,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVE NASAL FOREIGN BODY","code_information":[{"code":"30300","type":"CPT"}],"standard_charges":[{"minimum":126.61,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE NASAL FOREIGN BODY","code_information":[{"code":"30310","type":"CPT"}],"standard_charges":[{"minimum":220.29,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVE NASAL FOREIGN BODY","code_information":[{"code":"30320","type":"CPT"}],"standard_charges":[{"minimum":516.76,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF NOSE","code_information":[{"code":"30400","type":"CPT"}],"standard_charges":[{"minimum":1292.43,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF NOSE","code_information":[{"code":"30410","type":"CPT"}],"standard_charges":[{"minimum":1486.61,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF NOSE","code_information":[{"code":"30420","type":"CPT"}],"standard_charges":[{"minimum":1531.67,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1531.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1531.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1531.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30430","type":"CPT"}],"standard_charges":[{"minimum":1130.43,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30435","type":"CPT"}],"standard_charges":[{"minimum":1407.94,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30450","type":"CPT"}],"standard_charges":[{"minimum":1836.72,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1836.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1836.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1836.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30460","type":"CPT"}],"standard_charges":[{"minimum":870.8,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30462","type":"CPT"}],"standard_charges":[{"minimum":1672.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1672.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1672.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1672.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR NASAL STENOSIS","code_information":[{"code":"30465","type":"CPT"}],"standard_charges":[{"minimum":1083.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RPR NSL VLV COLLAPSE W/IMPLT","code_information":[{"code":"30468","type":"CPT"}],"standard_charges":[{"minimum":177.38,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF NASAL SEPTUM","code_information":[{"code":"30520","type":"CPT"}],"standard_charges":[{"minimum":714.16,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR NASAL DEFECT","code_information":[{"code":"30540","type":"CPT"}],"standard_charges":[{"minimum":781.75,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR NASAL DEFECT","code_information":[{"code":"30545","type":"CPT"}],"standard_charges":[{"minimum":1058.55,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF NASAL ADHESIONS","code_information":[{"code":"30560","type":"CPT"}],"standard_charges":[{"minimum":159.85,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"REPAIR UPPER JAW FISTULA","code_information":[{"code":"30580","type":"CPT"}],"standard_charges":[{"minimum":485.64,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR MOUTH/NOSE FISTULA","code_information":[{"code":"30600","type":"CPT"}],"standard_charges":[{"minimum":405.9,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"INTRANASAL RECONSTRUCTION","code_information":[{"code":"30620","type":"CPT"}],"standard_charges":[{"minimum":713.45,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR NASAL SEPTUM DEFECT","code_information":[{"code":"30630","type":"CPT"}],"standard_charges":[{"minimum":707.37,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"ABLATE INF TURBINATE SUPERF","code_information":[{"code":"30801","type":"CPT"}],"standard_charges":[{"minimum":160.57,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1967.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1475.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1475.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"ABLATE INF TURBINATE SUBMUC","code_information":[{"code":"30802","type":"CPT"}],"standard_charges":[{"minimum":213.85,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"CONTROL OF NOSEBLEED","code_information":[{"code":"30901","type":"CPT"}],"standard_charges":[{"minimum":59.01,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"CONTROL OF NOSEBLEED","code_information":[{"code":"30903","type":"CPT"}],"standard_charges":[{"minimum":80.46,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"CONTROL OF NOSEBLEED","code_information":[{"code":"30905","type":"CPT"}],"standard_charges":[{"minimum":110.5,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"REPEAT CONTROL OF NOSEBLEED","code_information":[{"code":"30906","type":"CPT"}],"standard_charges":[{"minimum":138.4,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"LIGATION NASAL SINUS ARTERY","code_information":[{"code":"30915","type":"CPT"}],"standard_charges":[{"minimum":638.7,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATION UPPER JAW ARTERY","code_information":[{"code":"30920","type":"CPT"}],"standard_charges":[{"minimum":921.22,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"THER FX NASAL INF TURBINATE","code_information":[{"code":"30930","type":"CPT"}],"standard_charges":[{"minimum":125.52,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"NASAL SURGERY PROCEDURE","code_information":[{"code":"30999","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"IRRIGATION MAXILLARY SINUS","code_information":[{"code":"31000","type":"CPT"}],"standard_charges":[{"minimum":117.3,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"IRRIGATION SPHENOID SINUS","code_information":[{"code":"31002","type":"CPT"}],"standard_charges":[{"minimum":199.91,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION MAXILLARY SINUS","code_information":[{"code":"31020","type":"CPT"}],"standard_charges":[{"minimum":360.84,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION MAXILLARY SINUS","code_information":[{"code":"31030","type":"CPT"}],"standard_charges":[{"minimum":542.86,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXPLORE SINUS REMOVE POLYPS","code_information":[{"code":"31032","type":"CPT"}],"standard_charges":[{"minimum":628.33,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION BEHIND UPPER JAW","code_information":[{"code":"31040","type":"CPT"}],"standard_charges":[{"minimum":851.49,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION SPHENOID SINUS","code_information":[{"code":"31050","type":"CPT"}],"standard_charges":[{"minimum":546.8,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"SPHENOID SINUS SURGERY","code_information":[{"code":"31051","type":"CPT"}],"standard_charges":[{"minimum":733.47,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF FRONTAL SINUS","code_information":[{"code":"31070","type":"CPT"}],"standard_charges":[{"minimum":503.17,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF FRONTAL SINUS","code_information":[{"code":"31075","type":"CPT"}],"standard_charges":[{"minimum":874.73,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31080","type":"CPT"}],"standard_charges":[{"minimum":1150.45,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31081","type":"CPT"}],"standard_charges":[{"minimum":1232.71,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31084","type":"CPT"}],"standard_charges":[{"minimum":1275.98,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31085","type":"CPT"}],"standard_charges":[{"minimum":1314.6,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1314.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1314.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1314.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31086","type":"CPT"}],"standard_charges":[{"minimum":1242.36,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1242.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1242.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1242.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31087","type":"CPT"}],"standard_charges":[{"minimum":1183,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF SINUSES","code_information":[{"code":"31090","type":"CPT"}],"standard_charges":[{"minimum":1169.77,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ETHMOID SINUS","code_information":[{"code":"31200","type":"CPT"}],"standard_charges":[{"minimum":661.59,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ETHMOID SINUS","code_information":[{"code":"31201","type":"CPT"}],"standard_charges":[{"minimum":823.59,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ETHMOID SINUS","code_information":[{"code":"31205","type":"CPT"}],"standard_charges":[{"minimum":993.1,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":993.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":993.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":993.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF UPPER JAW","code_information":[{"code":"31225","type":"CPT"}],"standard_charges":[{"minimum":1892.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1892.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1892.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1892.51,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF UPPER JAW","code_information":[{"code":"31230","type":"CPT"}],"standard_charges":[{"minimum":2111.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2111.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2111.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2111.37,"methodology":"fee schedule"}]}]},{"description":"NASAL ENDOSCOPY DX","code_information":[{"code":"31231","type":"CPT"}],"standard_charges":[{"minimum":67.59,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":208.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":213.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":212.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC DX MAX SINUSC","code_information":[{"code":"31233","type":"CPT"}],"standard_charges":[{"minimum":141.97,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":418.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":426.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":422.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC DX SPHN SINUSC","code_information":[{"code":"31235","type":"CPT"}],"standard_charges":[{"minimum":167.36,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31237","type":"CPT"}],"standard_charges":[{"minimum":167.72,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31238","type":"CPT"}],"standard_charges":[{"minimum":175.23,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31239","type":"CPT"}],"standard_charges":[{"minimum":637.63,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31240","type":"CPT"}],"standard_charges":[{"minimum":166.65,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC W/ARTERY LIG","code_information":[{"code":"31241","type":"CPT"}],"standard_charges":[{"minimum":464.54,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC TOTAL","code_information":[{"code":"31253","type":"CPT"}],"standard_charges":[{"minimum":521.05,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC W/PRTL ETHMDCT","code_information":[{"code":"31254","type":"CPT"}],"standard_charges":[{"minimum":253.91,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC W/TOT ETHMDCT","code_information":[{"code":"31255","type":"CPT"}],"standard_charges":[{"minimum":337.23,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION MAXILLARY SINUS","code_information":[{"code":"31256","type":"CPT"}],"standard_charges":[{"minimum":188.11,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC TOT W/SPHENDT","code_information":[{"code":"31257","type":"CPT"}],"standard_charges":[{"minimum":465.26,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC SPHN TISS RMVL","code_information":[{"code":"31259","type":"CPT"}],"standard_charges":[{"minimum":491.37,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY MAXILLARY SINUS","code_information":[{"code":"31267","type":"CPT"}],"standard_charges":[{"minimum":277.51,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC FRNT TISS RMVL","code_information":[{"code":"31276","type":"CPT"}],"standard_charges":[{"minimum":394.81,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31287","type":"CPT"}],"standard_charges":[{"minimum":210.28,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31288","type":"CPT"}],"standard_charges":[{"minimum":244.61,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31290","type":"CPT"}],"standard_charges":[{"minimum":1198.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31291","type":"CPT"}],"standard_charges":[{"minimum":1282.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.41,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC MED/INF DCMPRN","code_information":[{"code":"31292","type":"CPT"}],"standard_charges":[{"minimum":1038.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1038.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1038.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1038.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC MEDINF DCMPRN","code_information":[{"code":"31293","type":"CPT"}],"standard_charges":[{"minimum":1127.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC SURG ON DCMPRN","code_information":[{"code":"31294","type":"CPT"}],"standard_charges":[{"minimum":1287.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1287.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1287.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1287.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC SURG MAX SINS","code_information":[{"code":"31295","type":"CPT"}],"standard_charges":[{"minimum":164.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC SURG FRNT SINS","code_information":[{"code":"31296","type":"CPT"}],"standard_charges":[{"minimum":187.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC SURG SPHN SINS","code_information":[{"code":"31297","type":"CPT"}],"standard_charges":[{"minimum":150.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NSL/SINS NDSC SURG FRNTSPHN","code_information":[{"code":"31298","type":"CPT"}],"standard_charges":[{"minimum":267.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"SINUS SURGERY PROCEDURE","code_information":[{"code":"31299","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LARYNX LESION","code_information":[{"code":"31300","type":"CPT"}],"standard_charges":[{"minimum":1316.03,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LARYNX","code_information":[{"code":"31360","type":"CPT"}],"standard_charges":[{"minimum":2157.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2157.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2157.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2157.5,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LARYNX","code_information":[{"code":"31365","type":"CPT"}],"standard_charges":[{"minimum":2659.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2659.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2659.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2659.96,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31367","type":"CPT"}],"standard_charges":[{"minimum":2280.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2280.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2280.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2280.52,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31368","type":"CPT"}],"standard_charges":[{"minimum":2520.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2520.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2520.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2520.48,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31370","type":"CPT"}],"standard_charges":[{"minimum":2139.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2139.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2139.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2139.98,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31375","type":"CPT"}],"standard_charges":[{"minimum":2034.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2034.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2034.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2034.84,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31380","type":"CPT"}],"standard_charges":[{"minimum":2006.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.59,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31382","type":"CPT"}],"standard_charges":[{"minimum":2196.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2196.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2196.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2196.84,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LARYNX  PHARYNX","code_information":[{"code":"31390","type":"CPT"}],"standard_charges":[{"minimum":2934.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2934.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2934.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2934.25,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT LARYNX  PHARYNX","code_information":[{"code":"31395","type":"CPT"}],"standard_charges":[{"minimum":3077.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3077.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3077.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3077.65,"methodology":"fee schedule"}]}]},{"description":"REVISION OF LARYNX","code_information":[{"code":"31400","type":"CPT"}],"standard_charges":[{"minimum":1066.06,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EPIGLOTTIS","code_information":[{"code":"31420","type":"CPT"}],"standard_charges":[{"minimum":877.95,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"INSERT EMERGENCY AIRWAY","code_information":[{"code":"31500","type":"CPT"}],"standard_charges":[{"minimum":146.27,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":473.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":473.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"CHANGE OF WINDPIPE AIRWAY","code_information":[{"code":"31502","type":"CPT"}],"standard_charges":[{"minimum":36.48,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DIAGNOSTIC LARYNGOSCOPY","code_information":[{"code":"31505","type":"CPT"}],"standard_charges":[{"minimum":52.21,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":160.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":160.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":208.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":213.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":212.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY WITH BIOPSY","code_information":[{"code":"31510","type":"CPT"}],"standard_charges":[{"minimum":126.95,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY LARYNX","code_information":[{"code":"31511","type":"CPT"}],"standard_charges":[{"minimum":140.9,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":208.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":213.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":212.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LARYNX LESION","code_information":[{"code":"31512","type":"CPT"}],"standard_charges":[{"minimum":135.89,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"INJECTION INTO VOCAL CORD","code_information":[{"code":"31513","type":"CPT"}],"standard_charges":[{"minimum":137.68,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":418.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":426.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":422.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY FOR ASPIRATION","code_information":[{"code":"31515","type":"CPT"}],"standard_charges":[{"minimum":116.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":418.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":426.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":422.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"}]}]},{"description":"DX LARYNGOSCOPY NEWBORN","code_information":[{"code":"31520","type":"CPT"}],"standard_charges":[{"minimum":163.79,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":418.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":426.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":422.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"}]}]},{"description":"DX LARYNGOSCOPY EXCL NB","code_information":[{"code":"31525","type":"CPT"}],"standard_charges":[{"minimum":167.72,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"DX LARYNGOSCOPY W/OPER SCOPE","code_information":[{"code":"31526","type":"CPT"}],"standard_charges":[{"minimum":164.15,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY FOR TREATMENT","code_information":[{"code":"31527","type":"CPT"}],"standard_charges":[{"minimum":203.48,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY AND DILATION","code_information":[{"code":"31528","type":"CPT"}],"standard_charges":[{"minimum":150.91,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY AND DILATION","code_information":[{"code":"31529","type":"CPT"}],"standard_charges":[{"minimum":168.44,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY W/FB REMOVAL","code_information":[{"code":"31530","type":"CPT"}],"standard_charges":[{"minimum":207.42,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY W/FB  OP SCOPE","code_information":[{"code":"31531","type":"CPT"}],"standard_charges":[{"minimum":220.29,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY W/BIOPSY","code_information":[{"code":"31535","type":"CPT"}],"standard_charges":[{"minimum":197.4,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY W/BX  OP SCOPE","code_information":[{"code":"31536","type":"CPT"}],"standard_charges":[{"minimum":219.22,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY W/EXC OF TUMOR","code_information":[{"code":"31540","type":"CPT"}],"standard_charges":[{"minimum":251.4,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNSCOP W/TUMR EXC + SCOPE","code_information":[{"code":"31541","type":"CPT"}],"standard_charges":[{"minimum":274.29,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE VC LESION W/SCOPE","code_information":[{"code":"31545","type":"CPT"}],"standard_charges":[{"minimum":376.93,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE VC LESION SCOPE/GRAFT","code_information":[{"code":"31546","type":"CPT"}],"standard_charges":[{"minimum":570.76,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL STEN","code_information":[{"code":"31551","type":"CPT"}],"standard_charges":[{"minimum":1624.3,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL STEN","code_information":[{"code":"31552","type":"CPT"}],"standard_charges":[{"minimum":1567.79,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1567.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1567.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1567.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL STEN","code_information":[{"code":"31553","type":"CPT"}],"standard_charges":[{"minimum":1768.42,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1768.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1768.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1768.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL STEN","code_information":[{"code":"31554","type":"CPT"}],"standard_charges":[{"minimum":1769.13,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1769.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1769.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1769.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOP W/ARYTENOIDECTOM","code_information":[{"code":"31560","type":"CPT"}],"standard_charges":[{"minimum":325.07,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"LARYNSCOP REMVE CART + SCOP","code_information":[{"code":"31561","type":"CPT"}],"standard_charges":[{"minimum":355.47,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPE W/VC INJ","code_information":[{"code":"31570","type":"CPT"}],"standard_charges":[{"minimum":238.89,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOP W/VC INJ + SCOPE","code_information":[{"code":"31571","type":"CPT"}],"standard_charges":[{"minimum":259.63,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARGSC W/LASER DSTRJ LES","code_information":[{"code":"31572","type":"CPT"}],"standard_charges":[{"minimum":188.82,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARGSC W/THER INJECTION","code_information":[{"code":"31573","type":"CPT"}],"standard_charges":[{"minimum":155.92,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"LARGSC W/NJX AUGMENTATION","code_information":[{"code":"31574","type":"CPT"}],"standard_charges":[{"minimum":156.64,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"DIAGNOSTIC LARYNGOSCOPY","code_information":[{"code":"31575","type":"CPT"}],"standard_charges":[{"minimum":72.24,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":510.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":382.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":382.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":208.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":213.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":212.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY WITH BIOPSY","code_information":[{"code":"31576","type":"CPT"}],"standard_charges":[{"minimum":125.52,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"LARGSC W/RMVL FOREIGN BDY(S)","code_information":[{"code":"31577","type":"CPT"}],"standard_charges":[{"minimum":139.83,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":418.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":426.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":422.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"}]}]},{"description":"LARGSC W/REMOVAL LESION","code_information":[{"code":"31578","type":"CPT"}],"standard_charges":[{"minimum":156.64,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY TELESCOPIC","code_information":[{"code":"31579","type":"CPT"}],"standard_charges":[{"minimum":125.52,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":418.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":426.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":422.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL WEB","code_information":[{"code":"31580","type":"CPT"}],"standard_charges":[{"minimum":1350.72,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LARYNGOPLASTY FX RDCTJ FIXJ","code_information":[{"code":"31584","type":"CPT"}],"standard_charges":[{"minimum":1484.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LARYNGOPLASTY CRICOID SPLIT","code_information":[{"code":"31587","type":"CPT"}],"standard_charges":[{"minimum":1272.4,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1272.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1272.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1272.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REINNERVATE LARYNX","code_information":[{"code":"31590","type":"CPT"}],"standard_charges":[{"minimum":975.22,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LARYNGOPLASTY MEDIALIZATION","code_information":[{"code":"31591","type":"CPT"}],"standard_charges":[{"minimum":1160.82,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"CRICOTRACHEAL RESECTION","code_information":[{"code":"31592","type":"CPT"}],"standard_charges":[{"minimum":1822.42,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LARYNX SURGERY PROCEDURE","code_information":[{"code":"31599","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"INCISION OF WINDPIPE","code_information":[{"code":"31600","type":"CPT"}],"standard_charges":[{"minimum":316.49,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"INCISION OF WINDPIPE","code_information":[{"code":"31601","type":"CPT"}],"standard_charges":[{"minimum":469.55,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"INCISION OF WINDPIPE","code_information":[{"code":"31603","type":"CPT"}],"standard_charges":[{"minimum":332.23,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"INCISION OF WINDPIPE","code_information":[{"code":"31605","type":"CPT"}],"standard_charges":[{"minimum":247.5,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"INCISION OF WINDPIPE","code_information":[{"code":"31610","type":"CPT"}],"standard_charges":[{"minimum":1007.41,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"SURGERY/SPEECH PROSTHESIS","code_information":[{"code":"31611","type":"CPT"}],"standard_charges":[{"minimum":566.82,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PUNCTURE/CLEAR WINDPIPE","code_information":[{"code":"31612","type":"CPT"}],"standard_charges":[{"minimum":50.07,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR WINDPIPE OPENING","code_information":[{"code":"31613","type":"CPT"}],"standard_charges":[{"minimum":447.02,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR WINDPIPE OPENING","code_information":[{"code":"31614","type":"CPT"}],"standard_charges":[{"minimum":751,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":751,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":751,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":751,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"VISUALIZATION OF WINDPIPE","code_information":[{"code":"31615","type":"CPT"}],"standard_charges":[{"minimum":121.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"DX BRONCHOSCOPE/WASH","code_information":[{"code":"31622","type":"CPT"}],"standard_charges":[{"minimum":136.97,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"DX BRONCHOSCOPE/BRUSH","code_information":[{"code":"31623","type":"CPT"}],"standard_charges":[{"minimum":136.25,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"DX BRONCHOSCOPE/LAVAGE","code_information":[{"code":"31624","type":"CPT"}],"standard_charges":[{"minimum":138.04,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY W/BIOPSY(S)","code_information":[{"code":"31625","type":"CPT"}],"standard_charges":[{"minimum":161.29,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY W/MARKERS","code_information":[{"code":"31626","type":"CPT"}],"standard_charges":[{"minimum":203.13,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"NAVIGATIONAL BRONCHOSCOPY","code_information":[{"code":"31627","type":"CPT"}],"standard_charges":[{"minimum":99.06,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.06,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY/LUNG BX EACH","code_information":[{"code":"31628","type":"CPT"}],"standard_charges":[{"minimum":181.31,"maximum":4047.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY/NEEDLE BX EACH","code_information":[{"code":"31629","type":"CPT"}],"standard_charges":[{"minimum":192.4,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY DILATE/FX REPR","code_information":[{"code":"31630","type":"CPT"}],"standard_charges":[{"minimum":204.2,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY DILATE W/STENT","code_information":[{"code":"31631","type":"CPT"}],"standard_charges":[{"minimum":232.81,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY/LUNG BX ADDL","code_information":[{"code":"31632","type":"CPT"}],"standard_charges":[{"minimum":50.42,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY/NEEDLE BX ADDL","code_information":[{"code":"31633","type":"CPT"}],"standard_charges":[{"minimum":64.73,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.73,"methodology":"fee schedule"}]}]},{"description":"BRONCH W/BALLOON OCCLUSION","code_information":[{"code":"31634","type":"CPT"}],"standard_charges":[{"minimum":193.83,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY W/FB REMOVAL","code_information":[{"code":"31635","type":"CPT"}],"standard_charges":[{"minimum":180.95,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY BRONCH STENTS","code_information":[{"code":"31636","type":"CPT"}],"standard_charges":[{"minimum":222.8,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY STENT ADD-ON","code_information":[{"code":"31637","type":"CPT"}],"standard_charges":[{"minimum":78.32,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY REVISE STENT","code_information":[{"code":"31638","type":"CPT"}],"standard_charges":[{"minimum":253.19,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY W/TUMOR EXCISE","code_information":[{"code":"31640","type":"CPT"}],"standard_charges":[{"minimum":254.62,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY TREAT BLOCKAGE","code_information":[{"code":"31641","type":"CPT"}],"standard_charges":[{"minimum":261.78,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"DIAG BRONCHOSCOPE/CATHETER","code_information":[{"code":"31643","type":"CPT"}],"standard_charges":[{"minimum":174.87,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"BRNCHSC W/THER ASPIR 1ST","code_information":[{"code":"31645","type":"CPT"}],"standard_charges":[{"minimum":151.99,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"BRNCHSC W/THER ASPIR SBSQ","code_information":[{"code":"31646","type":"CPT"}],"standard_charges":[{"minimum":146.62,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":418.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":426.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":422.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"}]}]},{"description":"BRONCHIAL VALVE INIT INSERT","code_information":[{"code":"31647","type":"CPT"}],"standard_charges":[{"minimum":211.71,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"BRONCHIAL VALVE REMOV INIT","code_information":[{"code":"31648","type":"CPT"}],"standard_charges":[{"minimum":204.2,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"BRONCHIAL VALVE REMOV ADDL","code_information":[{"code":"31649","type":"CPT"}],"standard_charges":[{"minimum":68.66,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"BRONCHIAL VALVE ADDL INSERT","code_information":[{"code":"31651","type":"CPT"}],"standard_charges":[{"minimum":78.32,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"}]}]},{"description":"BRONCH EBUS SAMPLNG 1/2 NODE","code_information":[{"code":"31652","type":"CPT"}],"standard_charges":[{"minimum":227.09,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"BRONCH EBUS SAMPLNG 3/> NODE","code_information":[{"code":"31653","type":"CPT"}],"standard_charges":[{"minimum":251.76,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3968.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4047.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4008.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4027.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3929.63,"methodology":"fee schedule"}]}]},{"description":"BRONCH EBUS IVNTJ PERPH LES","code_information":[{"code":"31654","type":"CPT"}],"standard_charges":[{"minimum":69.02,"maximum":2326,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"}]}]},{"description":"BRONCH THERMOPLSTY 1 LOBE","code_information":[{"code":"31660","type":"CPT"}],"standard_charges":[{"minimum":2049.5,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"BRONCH THERMOPLSTY 2/> LOBES","code_information":[{"code":"31661","type":"CPT"}],"standard_charges":[{"minimum":2049.5,"maximum":7599.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7451.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7599.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7525.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7562.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7378.11,"methodology":"fee schedule"}]}]},{"description":"BRONCHIAL BRUSH BIOPSY","code_information":[{"code":"31717","type":"CPT"}],"standard_charges":[{"minimum":109.79,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1145.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":859.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":859.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":418.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":426.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":422.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":413.87,"methodology":"fee schedule"}]}]},{"description":"CLEARANCE OF AIRWAYS","code_information":[{"code":"31720","type":"CPT"}],"standard_charges":[{"minimum":50.42,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":218.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":221.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":222.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"}]}]},{"description":"CLEARANCE OF AIRWAYS","code_information":[{"code":"31725","type":"CPT"}],"standard_charges":[{"minimum":81.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"}]}]},{"description":"INTRO WINDPIPE WIRE/TUBE","code_information":[{"code":"31730","type":"CPT"}],"standard_charges":[{"minimum":153.06,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1856.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1893.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1874.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1883.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1837.97,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WINDPIPE","code_information":[{"code":"31750","type":"CPT"}],"standard_charges":[{"minimum":1419.02,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1419.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1419.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1419.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WINDPIPE","code_information":[{"code":"31755","type":"CPT"}],"standard_charges":[{"minimum":1818.84,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1818.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1818.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1818.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WINDPIPE","code_information":[{"code":"31760","type":"CPT"}],"standard_charges":[{"minimum":1417.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1417.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1417.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1417.59,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF WINDPIPE","code_information":[{"code":"31766","type":"CPT"}],"standard_charges":[{"minimum":1822.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.42,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT OF BRONCHUS","code_information":[{"code":"31770","type":"CPT"}],"standard_charges":[{"minimum":1363.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1363.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1363.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1363.95,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT BRONCHUS","code_information":[{"code":"31775","type":"CPT"}],"standard_charges":[{"minimum":1437.62,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1437.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1437.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1437.62,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT WINDPIPE","code_information":[{"code":"31780","type":"CPT"}],"standard_charges":[{"minimum":1259.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.88,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT WINDPIPE","code_information":[{"code":"31781","type":"CPT"}],"standard_charges":[{"minimum":1508.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.79,"methodology":"fee schedule"}]}]},{"description":"REMOVE WINDPIPE LESION","code_information":[{"code":"31785","type":"CPT"}],"standard_charges":[{"minimum":1128.28,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE WINDPIPE LESION","code_information":[{"code":"31786","type":"CPT"}],"standard_charges":[{"minimum":1481.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1481.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1481.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1481.25,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WINDPIPE INJURY","code_information":[{"code":"31800","type":"CPT"}],"standard_charges":[{"minimum":744.56,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WINDPIPE INJURY","code_information":[{"code":"31805","type":"CPT"}],"standard_charges":[{"minimum":846.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.84,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF WINDPIPE LESION","code_information":[{"code":"31820","type":"CPT"}],"standard_charges":[{"minimum":351.9,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF WINDPIPE DEFECT","code_information":[{"code":"31825","type":"CPT"}],"standard_charges":[{"minimum":514.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":514.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":514.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":514.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REVISE WINDPIPE SCAR","code_information":[{"code":"31830","type":"CPT"}],"standard_charges":[{"minimum":389.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"AIRWAYS SURGICAL PROCEDURE","code_information":[{"code":"31899","type":"CPT"}],"standard_charges":[{"minimum":122.16,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":208.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":213.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":212.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"}]}]},{"description":"THORACOSTOMY W/RIB RESECTION","code_information":[{"code":"32035","type":"CPT"}],"standard_charges":[{"minimum":762.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"}]}]},{"description":"THORACOSTOMY W/FLAP DRAINAGE","code_information":[{"code":"32036","type":"CPT"}],"standard_charges":[{"minimum":821.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.45,"methodology":"fee schedule"}]}]},{"description":"OPEN WEDGE/BX LUNG INFILTR","code_information":[{"code":"32096","type":"CPT"}],"standard_charges":[{"minimum":825.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.02,"methodology":"fee schedule"}]}]},{"description":"OPEN WEDGE/BX LUNG NODULE","code_information":[{"code":"32097","type":"CPT"}],"standard_charges":[{"minimum":826.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.45,"methodology":"fee schedule"}]}]},{"description":"OPEN BIOPSY OF LUNG PLEURA","code_information":[{"code":"32098","type":"CPT"}],"standard_charges":[{"minimum":781.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF CHEST","code_information":[{"code":"32100","type":"CPT"}],"standard_charges":[{"minimum":837.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/REPAIR CHEST","code_information":[{"code":"32110","type":"CPT"}],"standard_charges":[{"minimum":1524.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.16,"methodology":"fee schedule"}]}]},{"description":"RE-EXPLORATION OF CHEST","code_information":[{"code":"32120","type":"CPT"}],"standard_charges":[{"minimum":902.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.27,"methodology":"fee schedule"}]}]},{"description":"EXPLORE CHEST FREE ADHESIONS","code_information":[{"code":"32124","type":"CPT"}],"standard_charges":[{"minimum":953.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.05,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LUNG LESION(S)","code_information":[{"code":"32140","type":"CPT"}],"standard_charges":[{"minimum":1022.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE/TREAT LUNG LESIONS","code_information":[{"code":"32141","type":"CPT"}],"standard_charges":[{"minimum":1562.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1562.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1562.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1562.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LUNG LESION(S)","code_information":[{"code":"32150","type":"CPT"}],"standard_charges":[{"minimum":1051.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"}]}]},{"description":"REMOVE LUNG FOREIGN BODY","code_information":[{"code":"32151","type":"CPT"}],"standard_charges":[{"minimum":1037.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1037.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1037.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1037.45,"methodology":"fee schedule"}]}]},{"description":"OPEN CHEST HEART MASSAGE","code_information":[{"code":"32160","type":"CPT"}],"standard_charges":[{"minimum":826.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.1,"methodology":"fee schedule"}]}]},{"description":"DRAIN OPEN LUNG LESION","code_information":[{"code":"32200","type":"CPT"}],"standard_charges":[{"minimum":1178.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1178.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1178.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1178.35,"methodology":"fee schedule"}]}]},{"description":"TREAT CHEST LINING","code_information":[{"code":"32215","type":"CPT"}],"standard_charges":[{"minimum":830.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.74,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF LUNG","code_information":[{"code":"32220","type":"CPT"}],"standard_charges":[{"minimum":1649.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1649.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1649.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1649.33,"methodology":"fee schedule"}]}]},{"description":"PARTIAL RELEASE OF LUNG","code_information":[{"code":"32225","type":"CPT"}],"standard_charges":[{"minimum":1026.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF CHEST LINING","code_information":[{"code":"32310","type":"CPT"}],"standard_charges":[{"minimum":948.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.76,"methodology":"fee schedule"}]}]},{"description":"FREE/REMOVE CHEST LINING","code_information":[{"code":"32320","type":"CPT"}],"standard_charges":[{"minimum":1653.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.98,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BIOPSY CHEST LINING","code_information":[{"code":"32400","type":"CPT"}],"standard_charges":[{"minimum":86.54,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"CORE NDL BX LNG/MED PERQ","code_information":[{"code":"32408","type":"CPT"}],"standard_charges":[{"minimum":156.99,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVE LUNG PNEUMONECTOMY","code_information":[{"code":"32440","type":"CPT"}],"standard_charges":[{"minimum":1613.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1613.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1613.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1613.21,"methodology":"fee schedule"}]}]},{"description":"SLEEVE PNEUMONECTOMY","code_information":[{"code":"32442","type":"CPT"}],"standard_charges":[{"minimum":3122,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3122,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3122,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3122,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LUNG EXTRAPLEURAL","code_information":[{"code":"32445","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3615.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3615.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3615.51,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LUNG","code_information":[{"code":"32480","type":"CPT"}],"standard_charges":[{"minimum":1520.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1520.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1520.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1520.95,"methodology":"fee schedule"}]}]},{"description":"BILOBECTOMY","code_information":[{"code":"32482","type":"CPT"}],"standard_charges":[{"minimum":1625.73,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1625.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1625.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1625.73,"methodology":"fee schedule"}]}]},{"description":"SEGMENTECTOMY","code_information":[{"code":"32484","type":"CPT"}],"standard_charges":[{"minimum":1472.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1472.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1472.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1472.31,"methodology":"fee schedule"}]}]},{"description":"SLEEVE LOBECTOMY","code_information":[{"code":"32486","type":"CPT"}],"standard_charges":[{"minimum":2396.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2396.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2396.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2396.03,"methodology":"fee schedule"}]}]},{"description":"COMPLETION PNEUMONECTOMY","code_information":[{"code":"32488","type":"CPT"}],"standard_charges":[{"minimum":2451.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2451.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2451.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2451.11,"methodology":"fee schedule"}]}]},{"description":"LUNG VOLUME REDUCTION","code_information":[{"code":"32491","type":"CPT"}],"standard_charges":[{"minimum":1517.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1517.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1517.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1517.01,"methodology":"fee schedule"}]}]},{"description":"REPAIR BRONCHUS ADD-ON","code_information":[{"code":"32501","type":"CPT"}],"standard_charges":[{"minimum":248.19,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.19,"methodology":"fee schedule"}]}]},{"description":"RESECT APICAL LUNG TUMOR","code_information":[{"code":"32503","type":"CPT"}],"standard_charges":[{"minimum":1842.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1842.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1842.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1842.44,"methodology":"fee schedule"}]}]},{"description":"RESECT APICAL LUNG TUM/CHEST","code_information":[{"code":"32504","type":"CPT"}],"standard_charges":[{"minimum":2097.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.78,"methodology":"fee schedule"}]}]},{"description":"WEDGE RESECT OF LUNG INITIAL","code_information":[{"code":"32505","type":"CPT"}],"standard_charges":[{"minimum":960.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"}]}]},{"description":"WEDGE RESECT OF LUNG ADD-ON","code_information":[{"code":"32506","type":"CPT"}],"standard_charges":[{"minimum":159.14,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"}]}]},{"description":"WEDGE RESECT OF LUNG DIAG","code_information":[{"code":"32507","type":"CPT"}],"standard_charges":[{"minimum":158.78,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.78,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LUNG LESION","code_information":[{"code":"32540","type":"CPT"}],"standard_charges":[{"minimum":1775.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1775.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1775.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1775.57,"methodology":"fee schedule"}]}]},{"description":"INSERT PLEURAL CATH","code_information":[{"code":"32550","type":"CPT"}],"standard_charges":[{"minimum":210.28,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CHEST TUBE","code_information":[{"code":"32551","type":"CPT"}],"standard_charges":[{"minimum":160.57,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"REMOVE LUNG CATHETER","code_information":[{"code":"32552","type":"CPT"}],"standard_charges":[{"minimum":163.07,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"INS MARK THOR FOR RT PERQ","code_information":[{"code":"32553","type":"CPT"}],"standard_charges":[{"minimum":180.6,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1472.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1502.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1487.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1494.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"}]}]},{"description":"ASPIRATE PLEURA W/O IMAGING","code_information":[{"code":"32554","type":"CPT"}],"standard_charges":[{"minimum":91.55,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"ASPIRATE PLEURA W/ IMAGING","code_information":[{"code":"32555","type":"CPT"}],"standard_charges":[{"minimum":112.65,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"INSERT CATH PLEURA W/O IMAGE","code_information":[{"code":"32556","type":"CPT"}],"standard_charges":[{"minimum":128.38,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"INSERT CATH PLEURA W/ IMAGE","code_information":[{"code":"32557","type":"CPT"}],"standard_charges":[{"minimum":153.78,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"TREAT PLEURODESIS W/AGENT","code_information":[{"code":"32560","type":"CPT"}],"standard_charges":[{"minimum":78.32,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"LYSE CHEST FIBRIN INIT DAY","code_information":[{"code":"32561","type":"CPT"}],"standard_charges":[{"minimum":69.74,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"LYSE CHEST FIBRIN SUBQ DAY","code_information":[{"code":"32562","type":"CPT"}],"standard_charges":[{"minimum":62.23,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY DIAGNOSTIC","code_information":[{"code":"32601","type":"CPT"}],"standard_charges":[{"minimum":316.13,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY WBX SAC","code_information":[{"code":"32604","type":"CPT"}],"standard_charges":[{"minimum":490.29,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/BX MED SPACE","code_information":[{"code":"32606","type":"CPT"}],"standard_charges":[{"minimum":472.41,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/BX INFILTRATE","code_information":[{"code":"32607","type":"CPT"}],"standard_charges":[{"minimum":315.42,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/BX NODULE","code_information":[{"code":"32608","type":"CPT"}],"standard_charges":[{"minimum":387.66,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/BX PLEURA","code_information":[{"code":"32609","type":"CPT"}],"standard_charges":[{"minimum":263.21,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/PLEURODESIS","code_information":[{"code":"32650","type":"CPT"}],"standard_charges":[{"minimum":691.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.99,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY REMOVE CORTEX","code_information":[{"code":"32651","type":"CPT"}],"standard_charges":[{"minimum":1127.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY REM TOTL CORTEX","code_information":[{"code":"32652","type":"CPT"}],"standard_charges":[{"minimum":1708.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1708.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1708.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1708.34,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY REMOV FB/FIBRIN","code_information":[{"code":"32653","type":"CPT"}],"standard_charges":[{"minimum":1090.73,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.73,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY CONTRL BLEEDING","code_information":[{"code":"32654","type":"CPT"}],"standard_charges":[{"minimum":1218.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.76,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY RESECT BULLAE","code_information":[{"code":"32655","type":"CPT"}],"standard_charges":[{"minimum":986.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.67,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/PLEURECTOMY","code_information":[{"code":"32656","type":"CPT"}],"standard_charges":[{"minimum":829.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/SAC FB REMOVE","code_information":[{"code":"32658","type":"CPT"}],"standard_charges":[{"minimum":738.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.84,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/SAC DRAINAGE","code_information":[{"code":"32659","type":"CPT"}],"standard_charges":[{"minimum":759.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.58,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/PERICARD EXC","code_information":[{"code":"32661","type":"CPT"}],"standard_charges":[{"minimum":824.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.66,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/MEDIAST EXC","code_information":[{"code":"32662","type":"CPT"}],"standard_charges":[{"minimum":922.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.65,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/LOBECTOMY","code_information":[{"code":"32663","type":"CPT"}],"standard_charges":[{"minimum":1435.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.47,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/ TH NRV EXC","code_information":[{"code":"32664","type":"CPT"}],"standard_charges":[{"minimum":875.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.09,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOP W/ESOPH MUSC EXC","code_information":[{"code":"32665","type":"CPT"}],"standard_charges":[{"minimum":1265.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1265.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1265.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1265.61,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/WEDGE RESECT","code_information":[{"code":"32666","type":"CPT"}],"standard_charges":[{"minimum":897.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.98,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/W RESECT ADDL","code_information":[{"code":"32667","type":"CPT"}],"standard_charges":[{"minimum":159.5,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/W RESECT DIAG","code_information":[{"code":"32668","type":"CPT"}],"standard_charges":[{"minimum":159.5,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY REMOVE SEGMENT","code_information":[{"code":"32669","type":"CPT"}],"standard_charges":[{"minimum":1378.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1378.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1378.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1378.61,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY BILOBECTOMY","code_information":[{"code":"32670","type":"CPT"}],"standard_charges":[{"minimum":1641.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1641.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1641.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1641.82,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY PNEUMONECTOMY","code_information":[{"code":"32671","type":"CPT"}],"standard_charges":[{"minimum":1816.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.34,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY FOR LVRS","code_information":[{"code":"32672","type":"CPT"}],"standard_charges":[{"minimum":1557.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1557.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1557.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1557.42,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY W/THYMUS RESECT","code_information":[{"code":"32673","type":"CPT"}],"standard_charges":[{"minimum":1249.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1249.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1249.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1249.51,"methodology":"fee schedule"}]}]},{"description":"THORACOSCOPY LYMPH NODE EXC","code_information":[{"code":"32674","type":"CPT"}],"standard_charges":[{"minimum":219.22,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"}]}]},{"description":"THORAX STEREO RAD TARGETW/TX","code_information":[{"code":"32701","type":"CPT"}],"standard_charges":[{"minimum":214.93,"maximum":866.24,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":866.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":649.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":649.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR LUNG HERNIA","code_information":[{"code":"32800","type":"CPT"}],"standard_charges":[{"minimum":972.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.36,"methodology":"fee schedule"}]}]},{"description":"CLOSE CHEST AFTER DRAINAGE","code_information":[{"code":"32810","type":"CPT"}],"standard_charges":[{"minimum":931.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"}]}]},{"description":"CLOSE BRONCHIAL FISTULA","code_information":[{"code":"32815","type":"CPT"}],"standard_charges":[{"minimum":2872.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2872.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2872.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2872.74,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT INJURED CHEST","code_information":[{"code":"32820","type":"CPT"}],"standard_charges":[{"minimum":1373.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1373.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1373.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1373.96,"methodology":"fee schedule"}]}]},{"description":"DONOR PNEUMONECTOMY","code_information":[{"code":"32850","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUNG TRANSPLANT SINGLE","code_information":[{"code":"32851","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3351.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3351.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3351.23,"methodology":"fee schedule"}]}]},{"description":"LUNG TRANSPLANT WITH BYPASS","code_information":[{"code":"32852","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3609.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3609.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3609.79,"methodology":"fee schedule"}]}]},{"description":"LUNG TRANSPLANT DOUBLE","code_information":[{"code":"32853","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4681.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4681.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4681.21,"methodology":"fee schedule"}]}]},{"description":"LUNG TRANSPLANT WITH BYPASS","code_information":[{"code":"32854","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4956.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4956.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4956.21,"methodology":"fee schedule"}]}]},{"description":"PREPARE DONOR LUNG SINGLE","code_information":[{"code":"32855","type":"CPT"}],"standard_charges":[{"minimum":198.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.41,"methodology":"fee schedule"}]}]},{"description":"PREPARE DONOR LUNG DOUBLE","code_information":[{"code":"32856","type":"CPT"}],"standard_charges":[{"minimum":202.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RIB(S)","code_information":[{"code":"32900","type":"CPT"}],"standard_charges":[{"minimum":1400.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1400.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1400.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1400.43,"methodology":"fee schedule"}]}]},{"description":"REVISE  REPAIR CHEST WALL","code_information":[{"code":"32905","type":"CPT"}],"standard_charges":[{"minimum":1372.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1372.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1372.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1372.53,"methodology":"fee schedule"}]}]},{"description":"REVISE  REPAIR CHEST WALL","code_information":[{"code":"32906","type":"CPT"}],"standard_charges":[{"minimum":1691.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1691.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1691.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1691.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF LUNG","code_information":[{"code":"32940","type":"CPT"}],"standard_charges":[{"minimum":1268.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1268.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1268.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1268.83,"methodology":"fee schedule"}]}]},{"description":"THERAPEUTIC PNEUMOTHORAX","code_information":[{"code":"32960","type":"CPT"}],"standard_charges":[{"minimum":94.05,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"ABLATE PULM TUMOR PERQ CRYBL","code_information":[{"code":"32994","type":"CPT"}],"standard_charges":[{"minimum":449.17,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2645.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1984.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1984.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"TOTAL LUNG LAVAGE","code_information":[{"code":"32997","type":"CPT"}],"standard_charges":[{"minimum":348.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"}]}]},{"description":"ABLATE PULM TUMOR PERQ RF","code_information":[{"code":"32998","type":"CPT"}],"standard_charges":[{"minimum":449.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"CHEST SURGERY PROCEDURE","code_information":[{"code":"32999","type":"CPT"}],"standard_charges":[{"minimum":402.49,"maximum":4392.89,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"PERICARDIOCENTESIS W/IMAGING","code_information":[{"code":"33016","type":"CPT"}],"standard_charges":[{"minimum":239.25,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"PRCRD DRG 6YR+ W/O CGEN CAR","code_information":[{"code":"33017","type":"CPT"}],"standard_charges":[{"minimum":252.48,"maximum":9576.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9576.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7183.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.48,"methodology":"fee schedule"}]}]},{"description":"PRCRD DRG 0-5YR OR W/ANOMLY","code_information":[{"code":"33018","type":"CPT"}],"standard_charges":[{"minimum":294.68,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.68,"methodology":"fee schedule"}]}]},{"description":"PERQ PRCRD DRG INSJ CATH CT","code_information":[{"code":"33019","type":"CPT"}],"standard_charges":[{"minimum":216,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HEART SAC","code_information":[{"code":"33020","type":"CPT"}],"standard_charges":[{"minimum":847.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.91,"methodology":"fee schedule"}]}]},{"description":"INCISION OF HEART SAC","code_information":[{"code":"33025","type":"CPT"}],"standard_charges":[{"minimum":793.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.55,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF HEART SAC","code_information":[{"code":"33030","type":"CPT"}],"standard_charges":[{"minimum":2049.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2049.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2049.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2049.15,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF HEART SAC","code_information":[{"code":"33031","type":"CPT"}],"standard_charges":[{"minimum":2529.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2529.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2529.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2529.78,"methodology":"fee schedule"}]}]},{"description":"RESECT HEART SAC LESION","code_information":[{"code":"33050","type":"CPT"}],"standard_charges":[{"minimum":1038.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1038.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1038.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1038.52,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HEART LESION","code_information":[{"code":"33120","type":"CPT"}],"standard_charges":[{"minimum":2137.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2137.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2137.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2137.48,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HEART LESION","code_information":[{"code":"33130","type":"CPT"}],"standard_charges":[{"minimum":1398.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.28,"methodology":"fee schedule"}]}]},{"description":"HEART REVASCULARIZE (TMR)","code_information":[{"code":"33140","type":"CPT"}],"standard_charges":[{"minimum":1588.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.18,"methodology":"fee schedule"}]}]},{"description":"HEART TMR W/OTHER PROCEDURE","code_information":[{"code":"33141","type":"CPT"}],"standard_charges":[{"minimum":134.11,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"}]}]},{"description":"INSERT EPICARD ELTRD OPEN","code_information":[{"code":"33202","type":"CPT"}],"standard_charges":[{"minimum":793.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.55,"methodology":"fee schedule"}]}]},{"description":"INSERT EPICARD ELTRD ENDO","code_information":[{"code":"33203","type":"CPT"}],"standard_charges":[{"minimum":833.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.25,"methodology":"fee schedule"}]}]},{"description":"INSERT HEART PM ATRIAL","code_information":[{"code":"33206","type":"CPT"}],"standard_charges":[{"minimum":467.05,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11265.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11488.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11433.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"}]}]},{"description":"INSERT HEART PM VENTRICULAR","code_information":[{"code":"33207","type":"CPT"}],"standard_charges":[{"minimum":490.65,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11265.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11488.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11433.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"}]}]},{"description":"INSRT HEART PM ATRIAL  VENT","code_information":[{"code":"33208","type":"CPT"}],"standard_charges":[{"minimum":531.06,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11265.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11488.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11433.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"}]}]},{"description":"INSERT ELECTRD/PM CATH SNGL","code_information":[{"code":"33210","type":"CPT"}],"standard_charges":[{"minimum":164.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"INSERT CARD ELECTRODES DUAL","code_information":[{"code":"33211","type":"CPT"}],"standard_charges":[{"minimum":172.01,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"INSERT PULSE GEN SNGL LEAD","code_information":[{"code":"33212","type":"CPT"}],"standard_charges":[{"minimum":332.58,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"INSERT PULSE GEN DUAL LEADS","code_information":[{"code":"33213","type":"CPT"}],"standard_charges":[{"minimum":348.32,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11265.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11488.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11433.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"}]}]},{"description":"UPGRADE OF PACEMAKER SYSTEM","code_information":[{"code":"33214","type":"CPT"}],"standard_charges":[{"minimum":492.08,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11265.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11488.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11433.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"}]}]},{"description":"REPOSITION PACING-DEFIB LEAD","code_information":[{"code":"33215","type":"CPT"}],"standard_charges":[{"minimum":319.35,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT 1 ELECTRODE PM-DEFIB","code_information":[{"code":"33216","type":"CPT"}],"standard_charges":[{"minimum":382.29,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"INSERT 2 ELECTRODE PM-DEFIB","code_information":[{"code":"33217","type":"CPT"}],"standard_charges":[{"minimum":379.43,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"REPAIR LEAD PACE-DEFIB ONE","code_information":[{"code":"33218","type":"CPT"}],"standard_charges":[{"minimum":401.25,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"REPAIR LEAD PACE-DEFIB DUAL","code_information":[{"code":"33220","type":"CPT"}],"standard_charges":[{"minimum":391.95,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"INSERT PULSE GEN MULT LEADS","code_information":[{"code":"33221","type":"CPT"}],"standard_charges":[{"minimum":367.63,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20529.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20936.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20732.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20834.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"}]}]},{"description":"RELOCATION POCKET PACEMAKER","code_information":[{"code":"33222","type":"CPT"}],"standard_charges":[{"minimum":354.4,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"RELOCATE POCKET FOR DEFIB","code_information":[{"code":"33223","type":"CPT"}],"standard_charges":[{"minimum":420.92,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"INSERT PACING LEAD  CONNECT","code_information":[{"code":"33224","type":"CPT"}],"standard_charges":[{"minimum":521.76,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11265.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11488.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11433.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"}]}]},{"description":"L VENTRIC PACING LEAD ADD-ON","code_information":[{"code":"33225","type":"CPT"}],"standard_charges":[{"minimum":470.27,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"}]}]},{"description":"REPOSITION L VENTRIC LEAD","code_information":[{"code":"33226","type":"CPT"}],"standard_charges":[{"minimum":499.59,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REMOVEREPLACE PM GEN SINGL","code_information":[{"code":"33227","type":"CPT"}],"standard_charges":[{"minimum":349.03,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"REMVREPLC PM GEN DUAL LEAD","code_information":[{"code":"33228","type":"CPT"}],"standard_charges":[{"minimum":364.41,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11265.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11488.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11433.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11154.16,"methodology":"fee schedule"}]}]},{"description":"REMVREPLC PM GEN MULT LEADS","code_information":[{"code":"33229","type":"CPT"}],"standard_charges":[{"minimum":383.37,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20529.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20936.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20732.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20834.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"}]}]},{"description":"INSRT PULSE GEN W/DUAL LEADS","code_information":[{"code":"33230","type":"CPT"}],"standard_charges":[{"minimum":384.8,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24162.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24641.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24402.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24521.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"}]}]},{"description":"INSRT PULSE GEN W/MULT LEADS","code_information":[{"code":"33231","type":"CPT"}],"standard_charges":[{"minimum":412.33,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34513.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35197.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34855.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35026.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PM GENERATOR","code_information":[{"code":"33233","type":"CPT"}],"standard_charges":[{"minimum":241.03,"maximum":9085.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PACEMAKER SYSTEM","code_information":[{"code":"33234","type":"CPT"}],"standard_charges":[{"minimum":497.45,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"REMOVAL PACEMAKER ELECTRODE","code_information":[{"code":"33235","type":"CPT"}],"standard_charges":[{"minimum":653.37,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELECTRODE/THORACOTOMY","code_information":[{"code":"33236","type":"CPT"}],"standard_charges":[{"minimum":807.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.5,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELECTRODE/THORACOTOMY","code_information":[{"code":"33237","type":"CPT"}],"standard_charges":[{"minimum":866.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":866.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":866.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":866.51,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELECTRODE/THORACOTOMY","code_information":[{"code":"33238","type":"CPT"}],"standard_charges":[{"minimum":979.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.87,"methodology":"fee schedule"}]}]},{"description":"INSRT PULSE GEN W/SINGL LEAD","code_information":[{"code":"33240","type":"CPT"}],"standard_charges":[{"minimum":378.72,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24162.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24641.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24402.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24521.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"}]}]},{"description":"REMOVE PULSE GENERATOR","code_information":[{"code":"33241","type":"CPT"}],"standard_charges":[{"minimum":221.72,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELTRD/THORACOTOMY","code_information":[{"code":"33243","type":"CPT"}],"standard_charges":[{"minimum":1414.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1414.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1414.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1414.02,"methodology":"fee schedule"}]}]},{"description":"REMOVE ELCTRD TRANSVENOUSLY","code_information":[{"code":"33244","type":"CPT"}],"standard_charges":[{"minimum":885.82,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"INSJ/RPLCMT DEFIB W/LEAD(S)","code_information":[{"code":"33249","type":"CPT"}],"standard_charges":[{"minimum":934.81,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34513.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35197.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34855.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35026.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"}]}]},{"description":"ABLATE HEART DYSRHYTHM FOCUS","code_information":[{"code":"33250","type":"CPT"}],"standard_charges":[{"minimum":1488.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1488.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1488.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1488.76,"methodology":"fee schedule"}]}]},{"description":"ABLATE HEART DYSRHYTHM FOCUS","code_information":[{"code":"33251","type":"CPT"}],"standard_charges":[{"minimum":1670.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1670.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1670.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1670.79,"methodology":"fee schedule"}]}]},{"description":"ABLATE ATRIA LMTD","code_information":[{"code":"33254","type":"CPT"}],"standard_charges":[{"minimum":1398.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.64,"methodology":"fee schedule"}]}]},{"description":"ABLATE ATRIA W/O BYPASS EXT","code_information":[{"code":"33255","type":"CPT"}],"standard_charges":[{"minimum":1661.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1661.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1661.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1661.13,"methodology":"fee schedule"}]}]},{"description":"ABLATE ATRIA W/BYPASS EXTEN","code_information":[{"code":"33256","type":"CPT"}],"standard_charges":[{"minimum":1966.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.54,"methodology":"fee schedule"}]}]},{"description":"ABLATE ATRIA LMTD ADD-ON","code_information":[{"code":"33257","type":"CPT"}],"standard_charges":[{"minimum":600.08,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"}]}]},{"description":"ABLATE ATRIA X10SV ADD-ON","code_information":[{"code":"33258","type":"CPT"}],"standard_charges":[{"minimum":666.96,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.96,"methodology":"fee schedule"}]}]},{"description":"ABLATE ATRIA W/BYPASS ADD-ON","code_information":[{"code":"33259","type":"CPT"}],"standard_charges":[{"minimum":871.87,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.87,"methodology":"fee schedule"}]}]},{"description":"ABLATE HEART DYSRHYTHM FOCUS","code_information":[{"code":"33261","type":"CPT"}],"standard_charges":[{"minimum":1645.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1645.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1645.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1645.75,"methodology":"fee schedule"}]}]},{"description":"RMVL REPLC PULSE GEN 1 LEAD","code_information":[{"code":"33262","type":"CPT"}],"standard_charges":[{"minimum":382.65,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24162.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24641.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24402.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24521.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"}]}]},{"description":"RMVL  RPLCMT DFB GEN 2 LEAD","code_information":[{"code":"33263","type":"CPT"}],"standard_charges":[{"minimum":397.67,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24162.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24641.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24402.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24521.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23923.6,"methodology":"fee schedule"}]}]},{"description":"RMVL  RPLCMT DFB GEN MLT LD","code_information":[{"code":"33264","type":"CPT"}],"standard_charges":[{"minimum":414.48,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34513.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35197.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34855.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35026.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"}]}]},{"description":"ABLATE ATRIA LMTD ENDO","code_information":[{"code":"33265","type":"CPT"}],"standard_charges":[{"minimum":1397.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.57,"methodology":"fee schedule"}]}]},{"description":"ABLATE ATRIA X10SV ENDO","code_information":[{"code":"33266","type":"CPT"}],"standard_charges":[{"minimum":1885,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"}]}]},{"description":"INS/REP SUBQ DEFIBRILLATOR","code_information":[{"code":"33270","type":"CPT"}],"standard_charges":[{"minimum":574.69,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34513.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35197.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34855.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35026.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34171.87,"methodology":"fee schedule"}]}]},{"description":"INSJ SUBQ IMPLTBL DFB ELCTRD","code_information":[{"code":"33271","type":"CPT"}],"standard_charges":[{"minimum":467.41,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"RMVL OF SUBQ DEFIBRILLATOR","code_information":[{"code":"33272","type":"CPT"}],"standard_charges":[{"minimum":357.26,"maximum":137088,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":134921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137088,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"REPOS PREV IMPLTBL SUBQ DFB","code_information":[{"code":"33273","type":"CPT"}],"standard_charges":[{"minimum":413.76,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"TCAT INSJ/RPL PERM LDLS PM","code_information":[{"code":"33274","type":"CPT"}],"standard_charges":[{"minimum":490.29,"maximum":20936.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20529.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20936.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20732.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20834.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20326.42,"methodology":"fee schedule"}]}]},{"description":"TCAT RMVL PERM LDLS PM W/IMG","code_information":[{"code":"33275","type":"CPT"}],"standard_charges":[{"minimum":517.83,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSJ SUBQ CAR RHYTHM MNTR","code_information":[{"code":"33285","type":"CPT"}],"standard_charges":[{"minimum":89.4,"maximum":9085.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8908.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9085.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8997.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9041.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8820.71,"methodology":"fee schedule"}]}]},{"description":"RMVL SUBQ CAR RHYTHM MNTR","code_information":[{"code":"33286","type":"CPT"}],"standard_charges":[{"minimum":87.62,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"TCAT IMPL WRLS P-ART PRS SNR","code_information":[{"code":"33289","type":"CPT"}],"standard_charges":[{"minimum":340.81,"maximum":31208.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9576.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7183.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6679,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6786,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":30299.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":30602.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31208.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30905.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":30299.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30299.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":30299.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31056.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":30299.48,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART WOUND","code_information":[{"code":"33300","type":"CPT"}],"standard_charges":[{"minimum":2496.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2496.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2496.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2496.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART WOUND","code_information":[{"code":"33305","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4178.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4178.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4178.75,"methodology":"fee schedule"}]}]},{"description":"EXPLORATORY HEART SURGERY","code_information":[{"code":"33310","type":"CPT"}],"standard_charges":[{"minimum":1198.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.02,"methodology":"fee schedule"}]}]},{"description":"EXPLORATORY HEART SURGERY","code_information":[{"code":"33315","type":"CPT"}],"standard_charges":[{"minimum":1961.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1961.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1961.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1961.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR MAJOR BLOOD VESSEL(S)","code_information":[{"code":"33320","type":"CPT"}],"standard_charges":[{"minimum":1099.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR MAJOR VESSEL","code_information":[{"code":"33321","type":"CPT"}],"standard_charges":[{"minimum":1216.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.61,"methodology":"fee schedule"}]}]},{"description":"REPAIR MAJOR BLOOD VESSEL(S)","code_information":[{"code":"33322","type":"CPT"}],"standard_charges":[{"minimum":1434.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1434.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1434.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1434.76,"methodology":"fee schedule"}]}]},{"description":"INSERT MAJOR VESSEL GRAFT","code_information":[{"code":"33330","type":"CPT"}],"standard_charges":[{"minimum":1456.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"}]}]},{"description":"INSERT MAJOR VESSEL GRAFT","code_information":[{"code":"33335","type":"CPT"}],"standard_charges":[{"minimum":1906.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1906.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1906.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1906.1,"methodology":"fee schedule"}]}]},{"description":"PERQ CLSR TCAT L ATR APNDGE","code_information":[{"code":"33340","type":"CPT"}],"standard_charges":[{"minimum":794.98,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.98,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE PERQ","code_information":[{"code":"33361","type":"CPT"}],"standard_charges":[{"minimum":1232.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE OPEN","code_information":[{"code":"33362","type":"CPT"}],"standard_charges":[{"minimum":1342.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1342.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1342.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1342.85,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE OPEN","code_information":[{"code":"33363","type":"CPT"}],"standard_charges":[{"minimum":1393.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1393.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1393.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1393.63,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE OPEN","code_information":[{"code":"33364","type":"CPT"}],"standard_charges":[{"minimum":1387.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1387.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1387.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1387.91,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE OPEN","code_information":[{"code":"33365","type":"CPT"}],"standard_charges":[{"minimum":1451.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1451.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1451.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1451.93,"methodology":"fee schedule"}]}]},{"description":"TRCATH REPLACE AORTIC VALVE","code_information":[{"code":"33366","type":"CPT"}],"standard_charges":[{"minimum":1598.19,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1598.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1598.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1598.19,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE W/BYP","code_information":[{"code":"33367","type":"CPT"}],"standard_charges":[{"minimum":619.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.04,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE W/BYP","code_information":[{"code":"33368","type":"CPT"}],"standard_charges":[{"minimum":750.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.28,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE W/BYP","code_information":[{"code":"33369","type":"CPT"}],"standard_charges":[{"minimum":990.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.24,"methodology":"fee schedule"}]}]},{"description":"VALVULOPLASTY AORTIC VALVE","code_information":[{"code":"33390","type":"CPT"}],"standard_charges":[{"minimum":1965.11,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.11,"methodology":"fee schedule"}]}]},{"description":"VALVULOPLASTY AORTIC VALVE","code_information":[{"code":"33391","type":"CPT"}],"standard_charges":[{"minimum":2328.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2328.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2328.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2328.44,"methodology":"fee schedule"}]}]},{"description":"PREPARE HEART-AORTA CONDUIT","code_information":[{"code":"33404","type":"CPT"}],"standard_charges":[{"minimum":1786.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1786.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1786.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1786.3,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT AORTIC VALVE OPN","code_information":[{"code":"33405","type":"CPT"}],"standard_charges":[{"minimum":2321.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2321.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2321.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2321.65,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT AORTIC VALVE OPN","code_information":[{"code":"33406","type":"CPT"}],"standard_charges":[{"minimum":2947.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2947.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2947.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2947.84,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT AORTIC VALVE OPN","code_information":[{"code":"33410","type":"CPT"}],"standard_charges":[{"minimum":2596.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2596.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2596.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2596.66,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF AORTIC VALVE","code_information":[{"code":"33411","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3422.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3422.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3422.39,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF AORTIC VALVE","code_information":[{"code":"33412","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3199.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3199.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3199.24,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF AORTIC VALVE","code_information":[{"code":"33413","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3279.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3279.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3279.35,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF AORTIC VALVE","code_information":[{"code":"33414","type":"CPT"}],"standard_charges":[{"minimum":2196.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2196.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2196.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2196.84,"methodology":"fee schedule"}]}]},{"description":"REVISION SUBVALVULAR TISSUE","code_information":[{"code":"33415","type":"CPT"}],"standard_charges":[{"minimum":2073.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2073.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2073.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2073.82,"methodology":"fee schedule"}]}]},{"description":"REVISE VENTRICLE MUSCLE","code_information":[{"code":"33416","type":"CPT"}],"standard_charges":[{"minimum":2071.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2071.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2071.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2071.32,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF AORTIC VALVE","code_information":[{"code":"33417","type":"CPT"}],"standard_charges":[{"minimum":1714.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.77,"methodology":"fee schedule"}]}]},{"description":"REPAIR TCAT MITRAL VALVE","code_information":[{"code":"33418","type":"CPT"}],"standard_charges":[{"minimum":1839.22,"maximum":15906.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15906.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11932.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11932.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR TCAT MITRAL VALVE","code_information":[{"code":"33419","type":"CPT"}],"standard_charges":[{"minimum":430.93,"maximum":7953.47,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7953.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5966.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5966.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"}]}]},{"description":"REVISION OF MITRAL VALVE","code_information":[{"code":"33420","type":"CPT"}],"standard_charges":[{"minimum":1483.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1483.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1483.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1483.75,"methodology":"fee schedule"}]}]},{"description":"REVISION OF MITRAL VALVE","code_information":[{"code":"33422","type":"CPT"}],"standard_charges":[{"minimum":1700.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.11,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF MITRAL VALVE","code_information":[{"code":"33425","type":"CPT"}],"standard_charges":[{"minimum":2790.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2790.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2790.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2790.13,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF MITRAL VALVE","code_information":[{"code":"33426","type":"CPT"}],"standard_charges":[{"minimum":2437.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2437.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2437.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2437.16,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF MITRAL VALVE","code_information":[{"code":"33427","type":"CPT"}],"standard_charges":[{"minimum":2493.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2493.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2493.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2493.31,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF MITRAL VALVE","code_information":[{"code":"33430","type":"CPT"}],"standard_charges":[{"minimum":2864.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2864.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2864.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2864.87,"methodology":"fee schedule"}]}]},{"description":"RPLCMT A-VALVE TLCJ AUTOL PV","code_information":[{"code":"33440","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3459.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3459.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3459.23,"methodology":"fee schedule"}]}]},{"description":"REVISION OF TRICUSPID VALVE","code_information":[{"code":"33460","type":"CPT"}],"standard_charges":[{"minimum":2441.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2441.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2441.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2441.81,"methodology":"fee schedule"}]}]},{"description":"VALVULOPLASTY TRICUSPID","code_information":[{"code":"33463","type":"CPT"}],"standard_charges":[{"minimum":3142.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3142.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3142.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3142.38,"methodology":"fee schedule"}]}]},{"description":"VALVULOPLASTY TRICUSPID","code_information":[{"code":"33464","type":"CPT"}],"standard_charges":[{"minimum":2492.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2492.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2492.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2492.23,"methodology":"fee schedule"}]}]},{"description":"REPLACE TRICUSPID VALVE","code_information":[{"code":"33465","type":"CPT"}],"standard_charges":[{"minimum":2813.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2813.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2813.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2813.37,"methodology":"fee schedule"}]}]},{"description":"REVISION OF TRICUSPID VALVE","code_information":[{"code":"33468","type":"CPT"}],"standard_charges":[{"minimum":2504.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2504.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2504.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2504.75,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PULMONARY VALVE","code_information":[{"code":"33474","type":"CPT"}],"standard_charges":[{"minimum":2232.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2232.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2232.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2232.25,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT PULMONARY VALVE","code_information":[{"code":"33475","type":"CPT"}],"standard_charges":[{"minimum":2373.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2373.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2373.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2373.5,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33476","type":"CPT"}],"standard_charges":[{"minimum":1567.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1567.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1567.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1567.44,"methodology":"fee schedule"}]}]},{"description":"IMPLANT TCAT PULM VLV PERQ","code_information":[{"code":"33477","type":"CPT"}],"standard_charges":[{"minimum":1341.42,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.42,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33478","type":"CPT"}],"standard_charges":[{"minimum":1618.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR PROSTH VALVE CLOT","code_information":[{"code":"33496","type":"CPT"}],"standard_charges":[{"minimum":1700.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.83,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART VESSEL FISTULA","code_information":[{"code":"33500","type":"CPT"}],"standard_charges":[{"minimum":1594.97,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1594.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1594.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1594.97,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART VESSEL FISTULA","code_information":[{"code":"33501","type":"CPT"}],"standard_charges":[{"minimum":1142.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.94,"methodology":"fee schedule"}]}]},{"description":"CORONARY ARTERY CORRECTION","code_information":[{"code":"33502","type":"CPT"}],"standard_charges":[{"minimum":1317.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"}]}]},{"description":"CORONARY ARTERY GRAFT","code_information":[{"code":"33503","type":"CPT"}],"standard_charges":[{"minimum":1369.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1369.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1369.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1369.67,"methodology":"fee schedule"}]}]},{"description":"CORONARY ARTERY GRAFT","code_information":[{"code":"33504","type":"CPT"}],"standard_charges":[{"minimum":1509.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1509.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1509.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1509.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY W/TUNNEL","code_information":[{"code":"33505","type":"CPT"}],"standard_charges":[{"minimum":2103.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.15,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY TRANSLOCATION","code_information":[{"code":"33506","type":"CPT"}],"standard_charges":[{"minimum":2097.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.42,"methodology":"fee schedule"}]}]},{"description":"REPAIR ART INTRAMURAL","code_information":[{"code":"33507","type":"CPT"}],"standard_charges":[{"minimum":1760.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1760.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1760.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1760.91,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPIC VEIN HARVEST","code_information":[{"code":"33508","type":"CPT"}],"standard_charges":[{"minimum":16.45,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"}]}]},{"description":"CABG VEIN SINGLE","code_information":[{"code":"33510","type":"CPT"}],"standard_charges":[{"minimum":1978.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1978.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1978.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1978.34,"methodology":"fee schedule"}]}]},{"description":"CABG VEIN TWO","code_information":[{"code":"33511","type":"CPT"}],"standard_charges":[{"minimum":2172.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2172.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2172.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2172.52,"methodology":"fee schedule"}]}]},{"description":"CABG VEIN THREE","code_information":[{"code":"33512","type":"CPT"}],"standard_charges":[{"minimum":2474.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2474.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2474.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2474.35,"methodology":"fee schedule"}]}]},{"description":"CABG VEIN FOUR","code_information":[{"code":"33513","type":"CPT"}],"standard_charges":[{"minimum":2526.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2526.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2526.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2526.56,"methodology":"fee schedule"}]}]},{"description":"CABG VEIN FIVE","code_information":[{"code":"33514","type":"CPT"}],"standard_charges":[{"minimum":2657.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2657.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2657.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2657.81,"methodology":"fee schedule"}]}]},{"description":"CABG VEIN SIX OR MORE","code_information":[{"code":"33516","type":"CPT"}],"standard_charges":[{"minimum":2750.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2750.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2750.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2750.79,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERY-VEIN SINGLE","code_information":[{"code":"33517","type":"CPT"}],"standard_charges":[{"minimum":190.61,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERY-VEIN TWO","code_information":[{"code":"33518","type":"CPT"}],"standard_charges":[{"minimum":417.34,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.34,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERY-VEIN THREE","code_information":[{"code":"33519","type":"CPT"}],"standard_charges":[{"minimum":552.16,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.16,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERY-VEIN FOUR","code_information":[{"code":"33521","type":"CPT"}],"standard_charges":[{"minimum":661.95,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.95,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERY-VEIN FIVE","code_information":[{"code":"33522","type":"CPT"}],"standard_charges":[{"minimum":743.84,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"}]}]},{"description":"CABG ART-VEIN SIX OR MORE","code_information":[{"code":"33523","type":"CPT"}],"standard_charges":[{"minimum":837.54,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"}]}]},{"description":"CORONARY ARTERY BYPASS/REOP","code_information":[{"code":"33530","type":"CPT"}],"standard_charges":[{"minimum":532.85,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERIAL SINGLE","code_information":[{"code":"33533","type":"CPT"}],"standard_charges":[{"minimum":1916.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.11,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERIAL TWO","code_information":[{"code":"33534","type":"CPT"}],"standard_charges":[{"minimum":2249.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2249.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2249.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2249.77,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERIAL THREE","code_information":[{"code":"33535","type":"CPT"}],"standard_charges":[{"minimum":2499.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2499.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2499.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2499.74,"methodology":"fee schedule"}]}]},{"description":"CABG ARTERIAL FOUR OR MORE","code_information":[{"code":"33536","type":"CPT"}],"standard_charges":[{"minimum":2693.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2693.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2693.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2693.57,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HEART LESION","code_information":[{"code":"33542","type":"CPT"}],"standard_charges":[{"minimum":2679.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2679.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2679.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2679.27,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DAMAGE","code_information":[{"code":"33545","type":"CPT"}],"standard_charges":[{"minimum":3120.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3120.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3120.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3120.57,"methodology":"fee schedule"}]}]},{"description":"RESTORE/REMODEL VENTRICLE","code_information":[{"code":"33548","type":"CPT"}],"standard_charges":[{"minimum":3005.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3005.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3005.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3005.41,"methodology":"fee schedule"}]}]},{"description":"OPEN CORONARY ENDARTERECTOMY","code_information":[{"code":"33572","type":"CPT"}],"standard_charges":[{"minimum":234.6,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.6,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF VALVE","code_information":[{"code":"33600","type":"CPT"}],"standard_charges":[{"minimum":1766.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1766.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1766.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1766.63,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF VALVE","code_information":[{"code":"33602","type":"CPT"}],"standard_charges":[{"minimum":1715.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1715.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1715.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1715.13,"methodology":"fee schedule"}]}]},{"description":"ANASTOMOSIS/ARTERY-AORTA","code_information":[{"code":"33606","type":"CPT"}],"standard_charges":[{"minimum":1825.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.63,"methodology":"fee schedule"}]}]},{"description":"REPAIR ANOMALY W/CONDUIT","code_information":[{"code":"33608","type":"CPT"}],"standard_charges":[{"minimum":1848.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1848.88,"methodology":"fee schedule"}]}]},{"description":"REPAIR BY ENLARGEMENT","code_information":[{"code":"33610","type":"CPT"}],"standard_charges":[{"minimum":1823.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1823.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1823.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1823.49,"methodology":"fee schedule"}]}]},{"description":"REPAIR DOUBLE VENTRICLE","code_information":[{"code":"33611","type":"CPT"}],"standard_charges":[{"minimum":1995.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1995.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1995.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1995.15,"methodology":"fee schedule"}]}]},{"description":"REPAIR DOUBLE VENTRICLE","code_information":[{"code":"33612","type":"CPT"}],"standard_charges":[{"minimum":2048.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2048.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2048.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2048.43,"methodology":"fee schedule"}]}]},{"description":"REPAIR MODIFIED FONTAN","code_information":[{"code":"33615","type":"CPT"}],"standard_charges":[{"minimum":2047.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.71,"methodology":"fee schedule"}]}]},{"description":"REPAIR SINGLE VENTRICLE","code_information":[{"code":"33617","type":"CPT"}],"standard_charges":[{"minimum":2217.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2217.23,"methodology":"fee schedule"}]}]},{"description":"REPAIR SINGLE VENTRICLE","code_information":[{"code":"33619","type":"CPT"}],"standard_charges":[{"minimum":2816.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2816.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2816.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2816.23,"methodology":"fee schedule"}]}]},{"description":"APPLY RL PULM ART BANDS","code_information":[{"code":"33620","type":"CPT"}],"standard_charges":[{"minimum":1687.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1687.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1687.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1687.24,"methodology":"fee schedule"}]}]},{"description":"TRANSTHOR CATH FOR STENT","code_information":[{"code":"33621","type":"CPT"}],"standard_charges":[{"minimum":955.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":955.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":955.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":955.2,"methodology":"fee schedule"}]}]},{"description":"REDO COMPL CARDIAC ANOMALY","code_information":[{"code":"33622","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3499.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3499.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3499.64,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART SEPTUM DEFECT","code_information":[{"code":"33641","type":"CPT"}],"standard_charges":[{"minimum":1679.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HEART VEINS","code_information":[{"code":"33645","type":"CPT"}],"standard_charges":[{"minimum":1772.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1772.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1772.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1772.71,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART SEPTUM DEFECTS","code_information":[{"code":"33647","type":"CPT"}],"standard_charges":[{"minimum":1858.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1858.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1858.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1858.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33660","type":"CPT"}],"standard_charges":[{"minimum":1797.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1797.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1797.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1797.38,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33665","type":"CPT"}],"standard_charges":[{"minimum":1957.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1957.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1957.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1957.24,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART CHAMBERS","code_information":[{"code":"33670","type":"CPT"}],"standard_charges":[{"minimum":2013.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.03,"methodology":"fee schedule"}]}]},{"description":"CLOSE MULT VSD","code_information":[{"code":"33675","type":"CPT"}],"standard_charges":[{"minimum":2015.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2015.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2015.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2015.89,"methodology":"fee schedule"}]}]},{"description":"CLOSE MULT VSD W/RESECTION","code_information":[{"code":"33676","type":"CPT"}],"standard_charges":[{"minimum":2069.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2069.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2069.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2069.53,"methodology":"fee schedule"}]}]},{"description":"CL MULT VSD W/REM PUL BAND","code_information":[{"code":"33677","type":"CPT"}],"standard_charges":[{"minimum":2148.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2148.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2148.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2148.56,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART SEPTUM DEFECT","code_information":[{"code":"33681","type":"CPT"}],"standard_charges":[{"minimum":1894.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.65,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART SEPTUM DEFECT","code_information":[{"code":"33684","type":"CPT"}],"standard_charges":[{"minimum":1931.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1931.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1931.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1931.49,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART SEPTUM DEFECT","code_information":[{"code":"33688","type":"CPT"}],"standard_charges":[{"minimum":1922.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1922.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1922.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1922.91,"methodology":"fee schedule"}]}]},{"description":"REINFORCE PULMONARY ARTERY","code_information":[{"code":"33690","type":"CPT"}],"standard_charges":[{"minimum":1239.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1239.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1239.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1239.86,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33692","type":"CPT"}],"standard_charges":[{"minimum":1996.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1996.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1996.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1996.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33694","type":"CPT"}],"standard_charges":[{"minimum":1995.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1995.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1995.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1995.15,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33697","type":"CPT"}],"standard_charges":[{"minimum":2101.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2101.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2101.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2101.36,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33702","type":"CPT"}],"standard_charges":[{"minimum":1589.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.61,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33710","type":"CPT"}],"standard_charges":[{"minimum":2097.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.07,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HEART DEFECT","code_information":[{"code":"33720","type":"CPT"}],"standard_charges":[{"minimum":1590.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1590.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1590.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1590.68,"methodology":"fee schedule"}]}]},{"description":"REPAIR VENOUS ANOMALY","code_information":[{"code":"33724","type":"CPT"}],"standard_charges":[{"minimum":1574.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1574.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1574.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1574.95,"methodology":"fee schedule"}]}]},{"description":"REPAIR PUL VENOUS STENOSIS","code_information":[{"code":"33726","type":"CPT"}],"standard_charges":[{"minimum":2077.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2077.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2077.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2077.75,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART-VEIN DEFECT(S)","code_information":[{"code":"33730","type":"CPT"}],"standard_charges":[{"minimum":2055.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2055.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2055.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2055.94,"methodology":"fee schedule"}]}]},{"description":"REPAIR HEART-VEIN DEFECT","code_information":[{"code":"33732","type":"CPT"}],"standard_charges":[{"minimum":1695.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1695.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1695.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1695.1,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33735","type":"CPT"}],"standard_charges":[{"minimum":1337.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.13,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33736","type":"CPT"}],"standard_charges":[{"minimum":1449.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1449.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1449.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1449.42,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33737","type":"CPT"}],"standard_charges":[{"minimum":1337.49,"maximum":1337.49,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.49,"methodology":"fee schedule"}]}]},{"description":"TAS CONGENITAL CAR ANOMAL","code_information":[{"code":"33741","type":"CPT"}],"standard_charges":[{"minimum":765.3,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"}]}]},{"description":"TIS CGEN CAR ANOMAL 1ST SHNT","code_information":[{"code":"33745","type":"CPT"}],"standard_charges":[{"minimum":1093.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"}]}]},{"description":"TIS CGEN CAR ANOMAL EA ADDL","code_information":[{"code":"33746","type":"CPT"}],"standard_charges":[{"minimum":437.01,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.01,"methodology":"fee schedule"}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33750","type":"CPT"}],"standard_charges":[{"minimum":1296.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296.72,"methodology":"fee schedule"}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33755","type":"CPT"}],"standard_charges":[{"minimum":1358.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1358.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1358.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1358.23,"methodology":"fee schedule"}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33762","type":"CPT"}],"standard_charges":[{"minimum":1317.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.1,"methodology":"fee schedule"}]}]},{"description":"MAJOR VESSEL SHUNT  GRAFT","code_information":[{"code":"33764","type":"CPT"}],"standard_charges":[{"minimum":1358.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1358.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1358.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1358.23,"methodology":"fee schedule"}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33766","type":"CPT"}],"standard_charges":[{"minimum":1367.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1367.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1367.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1367.89,"methodology":"fee schedule"}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33767","type":"CPT"}],"standard_charges":[{"minimum":1459.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1459.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1459.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1459.79,"methodology":"fee schedule"}]}]},{"description":"CAVOPULMONARY SHUNTING","code_information":[{"code":"33768","type":"CPT"}],"standard_charges":[{"minimum":423.42,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.42,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33770","type":"CPT"}],"standard_charges":[{"minimum":2161.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2161.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2161.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2161.44,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33771","type":"CPT"}],"standard_charges":[{"minimum":2221.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2221.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2221.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2221.16,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33774","type":"CPT"}],"standard_charges":[{"minimum":1849.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1849.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1849.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1849.24,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33775","type":"CPT"}],"standard_charges":[{"minimum":1902.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1902.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1902.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1902.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33776","type":"CPT"}],"standard_charges":[{"minimum":2013.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33777","type":"CPT"}],"standard_charges":[{"minimum":1937.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1937.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1937.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1937.57,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33778","type":"CPT"}],"standard_charges":[{"minimum":2406.4,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2406.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2406.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2406.4,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33779","type":"CPT"}],"standard_charges":[{"minimum":2371.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2371.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2371.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2371.72,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33780","type":"CPT"}],"standard_charges":[{"minimum":2417.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2417.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2417.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2417.13,"methodology":"fee schedule"}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33781","type":"CPT"}],"standard_charges":[{"minimum":2357.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2357.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2357.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2357.41,"methodology":"fee schedule"}]}]},{"description":"NIKAIDOH PROC","code_information":[{"code":"33782","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":17500.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17500.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13127.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13127.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3291.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3291.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3291.86,"methodology":"fee schedule"}]}]},{"description":"NIKAIDOH PROC W/OSTIA IMPLT","code_information":[{"code":"33783","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":19064.68,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19064.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14300.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14300.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3557.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3557.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3557.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERIAL TRUNK","code_information":[{"code":"33786","type":"CPT"}],"standard_charges":[{"minimum":2327.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327.37,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PULMONARY ARTERY","code_information":[{"code":"33788","type":"CPT"}],"standard_charges":[{"minimum":1572.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1572.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1572.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1572.08,"methodology":"fee schedule"}]}]},{"description":"AORTIC SUSPENSION","code_information":[{"code":"33800","type":"CPT"}],"standard_charges":[{"minimum":1013.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.84,"methodology":"fee schedule"}]}]},{"description":"REPAIR VESSEL DEFECT","code_information":[{"code":"33802","type":"CPT"}],"standard_charges":[{"minimum":1120.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.77,"methodology":"fee schedule"}]}]},{"description":"REPAIR VESSEL DEFECT","code_information":[{"code":"33803","type":"CPT"}],"standard_charges":[{"minimum":1182.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.28,"methodology":"fee schedule"}]}]},{"description":"REPAIR SEPTAL DEFECT","code_information":[{"code":"33813","type":"CPT"}],"standard_charges":[{"minimum":1278.48,"maximum":1278.48,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.48,"methodology":"fee schedule"}]}]},{"description":"REPAIR SEPTAL DEFECT","code_information":[{"code":"33814","type":"CPT"}],"standard_charges":[{"minimum":1568.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1568.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1568.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1568.51,"methodology":"fee schedule"}]}]},{"description":"REVISE MAJOR VESSEL","code_information":[{"code":"33820","type":"CPT"}],"standard_charges":[{"minimum":996.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.32,"methodology":"fee schedule"}]}]},{"description":"REVISE MAJOR VESSEL","code_information":[{"code":"33822","type":"CPT"}],"standard_charges":[{"minimum":1050.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.32,"methodology":"fee schedule"}]}]},{"description":"REVISE MAJOR VESSEL","code_information":[{"code":"33824","type":"CPT"}],"standard_charges":[{"minimum":1218.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.04,"methodology":"fee schedule"}]}]},{"description":"REMOVE AORTA CONSTRICTION","code_information":[{"code":"33840","type":"CPT"}],"standard_charges":[{"minimum":1277.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1277.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1277.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1277.05,"methodology":"fee schedule"}]}]},{"description":"REMOVE AORTA CONSTRICTION","code_information":[{"code":"33845","type":"CPT"}],"standard_charges":[{"minimum":1375.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1375.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1375.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1375.75,"methodology":"fee schedule"}]}]},{"description":"REMOVE AORTA CONSTRICTION","code_information":[{"code":"33851","type":"CPT"}],"standard_charges":[{"minimum":1311.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.38,"methodology":"fee schedule"}]}]},{"description":"REPAIR SEPTAL DEFECT","code_information":[{"code":"33852","type":"CPT"}],"standard_charges":[{"minimum":1440.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1440.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1440.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1440.12,"methodology":"fee schedule"}]}]},{"description":"REPAIR SEPTAL DEFECT","code_information":[{"code":"33853","type":"CPT"}],"standard_charges":[{"minimum":1882.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1882.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1882.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1882.85,"methodology":"fee schedule"}]}]},{"description":"AS-AORT GRF F/AORTIC DSJ","code_information":[{"code":"33858","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3458.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3458.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3458.51,"methodology":"fee schedule"}]}]},{"description":"AS-AORT GRF F/DS OTH/THN DSJ","code_information":[{"code":"33859","type":"CPT"}],"standard_charges":[{"minimum":2486.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2486.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2486.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2486.15,"methodology":"fee schedule"}]}]},{"description":"ASCENDING AORTIC GRAFT","code_information":[{"code":"33863","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3205.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3205.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3205.68,"methodology":"fee schedule"}]}]},{"description":"ASCENDING AORTIC GRAFT","code_information":[{"code":"33864","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3273.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3273.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3273.63,"methodology":"fee schedule"}]}]},{"description":"AORTIC HEMIARCH GRAFT","code_information":[{"code":"33866","type":"CPT"}],"standard_charges":[{"minimum":934.81,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.81,"methodology":"fee schedule"}]}]},{"description":"TRANSVRS A-ARCH GRF HYPTHRM","code_information":[{"code":"33871","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3318.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3318.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3318.33,"methodology":"fee schedule"}]}]},{"description":"THORACIC AORTIC GRAFT","code_information":[{"code":"33875","type":"CPT"}],"standard_charges":[{"minimum":2800.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2800.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2800.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2800.5,"methodology":"fee schedule"}]}]},{"description":"THORACOABDOMINAL GRAFT","code_information":[{"code":"33877","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3672.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3672.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3672.01,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC TAA REPR INCL SUBCL","code_information":[{"code":"33880","type":"CPT"}],"standard_charges":[{"minimum":1817.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1817.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1817.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1817.05,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC TAA REPR W/O SUBCL","code_information":[{"code":"33881","type":"CPT"}],"standard_charges":[{"minimum":1560.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1560.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1560.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1560.64,"methodology":"fee schedule"}]}]},{"description":"INSERT ENDOVASC PROSTH TAA","code_information":[{"code":"33883","type":"CPT"}],"standard_charges":[{"minimum":1132.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1132.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1132.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1132.93,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC PROSTH TAA ADD-ON","code_information":[{"code":"33884","type":"CPT"}],"standard_charges":[{"minimum":400.17,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.17,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC PROSTH DELAYED","code_information":[{"code":"33886","type":"CPT"}],"standard_charges":[{"minimum":978.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.08,"methodology":"fee schedule"}]}]},{"description":"ARTERY TRANSPOSE/ENDOVAS TAA","code_information":[{"code":"33889","type":"CPT"}],"standard_charges":[{"minimum":806.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":806.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":806.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":806.78,"methodology":"fee schedule"}]}]},{"description":"CAR-CAR BP GRFT/ENDOVAS TAA","code_information":[{"code":"33891","type":"CPT"}],"standard_charges":[{"minimum":975.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.58,"methodology":"fee schedule"}]}]},{"description":"REMOVE LUNG ARTERY EMBOLI","code_information":[{"code":"33910","type":"CPT"}],"standard_charges":[{"minimum":2663.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2663.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2663.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2663.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE LUNG ARTERY EMBOLI","code_information":[{"code":"33915","type":"CPT"}],"standard_charges":[{"minimum":1404,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"}]}]},{"description":"SURGERY OF GREAT VESSEL","code_information":[{"code":"33916","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4248.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4248.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4248.49,"methodology":"fee schedule"}]}]},{"description":"REPAIR PULMONARY ARTERY","code_information":[{"code":"33917","type":"CPT"}],"standard_charges":[{"minimum":1501.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1501.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1501.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1501.28,"methodology":"fee schedule"}]}]},{"description":"REPAIR PULMONARY ATRESIA","code_information":[{"code":"33920","type":"CPT"}],"standard_charges":[{"minimum":1853.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1853.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1853.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1853.17,"methodology":"fee schedule"}]}]},{"description":"TRANSECT PULMONARY ARTERY","code_information":[{"code":"33922","type":"CPT"}],"standard_charges":[{"minimum":1430.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.47,"methodology":"fee schedule"}]}]},{"description":"REMOVE PULMONARY SHUNT","code_information":[{"code":"33924","type":"CPT"}],"standard_charges":[{"minimum":290.03,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.03,"methodology":"fee schedule"}]}]},{"description":"RPR PUL ART UNIFOCAL W/O CPB","code_information":[{"code":"33925","type":"CPT"}],"standard_charges":[{"minimum":1755.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1755.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1755.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1755.54,"methodology":"fee schedule"}]}]},{"description":"REPR PUL ART UNIFOCAL W/CPB","code_information":[{"code":"33926","type":"CPT"}],"standard_charges":[{"minimum":2466.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2466.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2466.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2466.84,"methodology":"fee schedule"}]}]},{"description":"IMPLTJ TOT RPLCMT HRT SYS","code_information":[{"code":"33927","type":"CPT"}],"standard_charges":[{"minimum":2592.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2592.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2592.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2592.37,"methodology":"fee schedule"}]}]},{"description":"RMVL  RPLCMT TOT HRT SYS","code_information":[{"code":"33928","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RMVL RPLCMT HRT SYS F/TRNSPL","code_information":[{"code":"33929","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF DONOR HEART/LUNG","code_information":[{"code":"33930","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREPARE DONOR HEART/LUNG","code_information":[{"code":"33933","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANTATION HEART/LUNG","code_information":[{"code":"33935","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5014.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5014.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5014.15,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF DONOR HEART","code_information":[{"code":"33940","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREPARE DONOR HEART","code_information":[{"code":"33944","type":"CPT"}],"standard_charges":[{"minimum":211.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.07,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANTATION OF HEART","code_information":[{"code":"33945","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4963.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4963.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4963.72,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INITIATION VENOUS","code_information":[{"code":"33946","type":"CPT"}],"standard_charges":[{"minimum":316.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INITIATION ARTERY","code_information":[{"code":"33947","type":"CPT"}],"standard_charges":[{"minimum":349.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS DAILY MGMT-VENOUS","code_information":[{"code":"33948","type":"CPT"}],"standard_charges":[{"minimum":243.89,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS DAILY MGMT ARTERY","code_information":[{"code":"33949","type":"CPT"}],"standard_charges":[{"minimum":238.17,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.17,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ PRPH CANNULA","code_information":[{"code":"33951","type":"CPT"}],"standard_charges":[{"minimum":428.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.43,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ PRPH CANNULA","code_information":[{"code":"33952","type":"CPT"}],"standard_charges":[{"minimum":435.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.22,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ PRPH CANNULA","code_information":[{"code":"33953","type":"CPT"}],"standard_charges":[{"minimum":478.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":478.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":478.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":478.49,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ PRPH CANNULA","code_information":[{"code":"33954","type":"CPT"}],"standard_charges":[{"minimum":484.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.21,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ CTR CANNULA","code_information":[{"code":"33955","type":"CPT"}],"standard_charges":[{"minimum":837.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ CTR CANNULA","code_information":[{"code":"33956","type":"CPT"}],"standard_charges":[{"minimum":850.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":850.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":850.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":850.41,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33957","type":"CPT"}],"standard_charges":[{"minimum":186.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33958","type":"CPT"}],"standard_charges":[{"minimum":186.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33959","type":"CPT"}],"standard_charges":[{"minimum":237.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33962","type":"CPT"}],"standard_charges":[{"minimum":237.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33963","type":"CPT"}],"standard_charges":[{"minimum":472.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.77,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33964","type":"CPT"}],"standard_charges":[{"minimum":499.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS RMVL PERPH CANNULA","code_information":[{"code":"33965","type":"CPT"}],"standard_charges":[{"minimum":186.68,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS RMVL PRPH CANNULA","code_information":[{"code":"33966","type":"CPT"}],"standard_charges":[{"minimum":241.39,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.39,"methodology":"fee schedule"}]}]},{"description":"INSERT I-AORT PERCUT DEVICE","code_information":[{"code":"33967","type":"CPT"}],"standard_charges":[{"minimum":263.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.56,"methodology":"fee schedule"}]}]},{"description":"REMOVE AORTIC ASSIST DEVICE","code_information":[{"code":"33968","type":"CPT"}],"standard_charges":[{"minimum":34.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS RMVL PERPH CANNULA","code_information":[{"code":"33969","type":"CPT"}],"standard_charges":[{"minimum":276.08,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.08,"methodology":"fee schedule"}]}]},{"description":"AORTIC CIRCULATION ASSIST","code_information":[{"code":"33970","type":"CPT"}],"standard_charges":[{"minimum":359.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.41,"methodology":"fee schedule"}]}]},{"description":"AORTIC CIRCULATION ASSIST","code_information":[{"code":"33971","type":"CPT"}],"standard_charges":[{"minimum":728.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.82,"methodology":"fee schedule"}]}]},{"description":"INSERT BALLOON DEVICE","code_information":[{"code":"33973","type":"CPT"}],"standard_charges":[{"minimum":507.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"}]}]},{"description":"REMOVE INTRA-AORTIC BALLOON","code_information":[{"code":"33974","type":"CPT"}],"standard_charges":[{"minimum":915.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.86,"methodology":"fee schedule"}]}]},{"description":"IMPLANT VENTRICULAR DEVICE","code_information":[{"code":"33975","type":"CPT"}],"standard_charges":[{"minimum":1326.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1326.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1326.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1326.76,"methodology":"fee schedule"}]}]},{"description":"IMPLANT VENTRICULAR DEVICE","code_information":[{"code":"33976","type":"CPT"}],"standard_charges":[{"minimum":1603.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1603.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1603.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1603.2,"methodology":"fee schedule"}]}]},{"description":"REMOVE VENTRICULAR DEVICE","code_information":[{"code":"33977","type":"CPT"}],"standard_charges":[{"minimum":1145.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1145.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1145.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1145.45,"methodology":"fee schedule"}]}]},{"description":"REMOVE VENTRICULAR DEVICE","code_information":[{"code":"33978","type":"CPT"}],"standard_charges":[{"minimum":1350.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.36,"methodology":"fee schedule"}]}]},{"description":"INSERT INTRACORPOREAL DEVICE","code_information":[{"code":"33979","type":"CPT"}],"standard_charges":[{"minimum":1977.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1977.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1977.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1977.26,"methodology":"fee schedule"}]}]},{"description":"REMOVE INTRACORPOREAL DEVICE","code_information":[{"code":"33980","type":"CPT"}],"standard_charges":[{"minimum":1816.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.34,"methodology":"fee schedule"}]}]},{"description":"REPLACE VAD PUMP EXT","code_information":[{"code":"33981","type":"CPT"}],"standard_charges":[{"minimum":839.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":839.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":839.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":839.33,"methodology":"fee schedule"}]}]},{"description":"REPLACE VAD INTRA W/O BP","code_information":[{"code":"33982","type":"CPT"}],"standard_charges":[{"minimum":1973.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1973.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1973.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1973.69,"methodology":"fee schedule"}]}]},{"description":"REPLACE VAD INTRA W/BP","code_information":[{"code":"33983","type":"CPT"}],"standard_charges":[{"minimum":2322.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2322.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2322.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2322.36,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS RMVL PRPH CANNULA","code_information":[{"code":"33984","type":"CPT"}],"standard_charges":[{"minimum":288.6,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS RMVL CTR CANNULA","code_information":[{"code":"33985","type":"CPT"}],"standard_charges":[{"minimum":519.26,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.26,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS RMVL CTR CANNULA","code_information":[{"code":"33986","type":"CPT"}],"standard_charges":[{"minimum":532.85,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.85,"methodology":"fee schedule"}]}]},{"description":"ARTERY EXPOS/GRAFT ARTERY","code_information":[{"code":"33987","type":"CPT"}],"standard_charges":[{"minimum":210.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF LEFT HEART VENT","code_information":[{"code":"33988","type":"CPT"}],"standard_charges":[{"minimum":785.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.68,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LEFT HEART VENT","code_information":[{"code":"33989","type":"CPT"}],"standard_charges":[{"minimum":499.23,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"}]}]},{"description":"INSERT VAD ARTERY ACCESS","code_information":[{"code":"33990","type":"CPT"}],"standard_charges":[{"minimum":367.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.27,"methodology":"fee schedule"}]}]},{"description":"INSERT VAD ARTVEIN ACCESS","code_information":[{"code":"33991","type":"CPT"}],"standard_charges":[{"minimum":460.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAD DIFFERENT SESSION","code_information":[{"code":"33992","type":"CPT"}],"standard_charges":[{"minimum":191.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"}]}]},{"description":"REPOSG PERQ R/L HRT VAD","code_information":[{"code":"33993","type":"CPT"}],"standard_charges":[{"minimum":169.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"}]}]},{"description":"INSJ PERQ VAD R HRT VENOUS","code_information":[{"code":"33995","type":"CPT"}],"standard_charges":[{"minimum":361.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.55,"methodology":"fee schedule"}]}]},{"description":"RMVL PERQ RIGHT HEART VAD","code_information":[{"code":"33997","type":"CPT"}],"standard_charges":[{"minimum":164.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"}]}]},{"description":"CARDIAC SURGERY PROCEDURE","code_information":[{"code":"33999","type":"CPT"}],"standard_charges":[{"minimum":402.49,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARTERY CLOT","code_information":[{"code":"34001","type":"CPT"}],"standard_charges":[{"minimum":932.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.31,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARTERY CLOT","code_information":[{"code":"34051","type":"CPT"}],"standard_charges":[{"minimum":1019.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.92,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARTERY CLOT","code_information":[{"code":"34101","type":"CPT"}],"standard_charges":[{"minimum":608.31,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARM ARTERY CLOT","code_information":[{"code":"34111","type":"CPT"}],"standard_charges":[{"minimum":607.59,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARTERY CLOT","code_information":[{"code":"34151","type":"CPT"}],"standard_charges":[{"minimum":1416.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.88,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ARTERY CLOT","code_information":[{"code":"34201","type":"CPT"}],"standard_charges":[{"minimum":1039.95,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LEG ARTERY CLOT","code_information":[{"code":"34203","type":"CPT"}],"standard_charges":[{"minimum":966.64,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34401","type":"CPT"}],"standard_charges":[{"minimum":1533.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34421","type":"CPT"}],"standard_charges":[{"minimum":709.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34451","type":"CPT"}],"standard_charges":[{"minimum":1461.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.94,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34471","type":"CPT"}],"standard_charges":[{"minimum":658.95,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1100.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1100.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1100.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34490","type":"CPT"}],"standard_charges":[{"minimum":587.92,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR VALVE FEMORAL VEIN","code_information":[{"code":"34501","type":"CPT"}],"standard_charges":[{"minimum":915.14,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT VENA CAVA","code_information":[{"code":"34502","type":"CPT"}],"standard_charges":[{"minimum":1586.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.03,"methodology":"fee schedule"}]}]},{"description":"TRANSPOSITION OF VEIN VALVE","code_information":[{"code":"34510","type":"CPT"}],"standard_charges":[{"minimum":1041.38,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1041.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1041.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1041.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"CROSS-OVER VEIN GRAFT","code_information":[{"code":"34520","type":"CPT"}],"standard_charges":[{"minimum":1008.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"LEG VEIN FUSION","code_information":[{"code":"34530","type":"CPT"}],"standard_charges":[{"minimum":961.27,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":961.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":961.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":961.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR A-AO NDGFT","code_information":[{"code":"34701","type":"CPT"}],"standard_charges":[{"minimum":1255.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1255.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1255.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1255.59,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR A-AO NDGFT RPT","code_information":[{"code":"34702","type":"CPT"}],"standard_charges":[{"minimum":1874.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1874.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1874.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1874.27,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR A-UNILAC NDGFT","code_information":[{"code":"34703","type":"CPT"}],"standard_charges":[{"minimum":1394.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1394.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1394.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1394.35,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR A-UNILAC NDGFT RPT","code_information":[{"code":"34704","type":"CPT"}],"standard_charges":[{"minimum":2324.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2324.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2324.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2324.51,"methodology":"fee schedule"}]}]},{"description":"EVAC RPR A-BIILIAC NDGFT","code_information":[{"code":"34705","type":"CPT"}],"standard_charges":[{"minimum":1550.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1550.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1550.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1550.63,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR A-BIILIAC RPT","code_information":[{"code":"34706","type":"CPT"}],"standard_charges":[{"minimum":2310.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2310.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2310.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2310.56,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR ILIO-ILIAC NDGFT","code_information":[{"code":"34707","type":"CPT"}],"standard_charges":[{"minimum":1179.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.06,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR ILIO-ILIAC RPT","code_information":[{"code":"34708","type":"CPT"}],"standard_charges":[{"minimum":1847.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1847.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1847.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1847.09,"methodology":"fee schedule"}]}]},{"description":"PLMT XTN PROSTH EVASC RPR","code_information":[{"code":"34709","type":"CPT"}],"standard_charges":[{"minimum":326.5,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.5,"methodology":"fee schedule"}]}]},{"description":"DLYD PLMT XTN PROSTH 1ST VSL","code_information":[{"code":"34710","type":"CPT"}],"standard_charges":[{"minimum":810,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":810,"methodology":"fee schedule"}]}]},{"description":"DLYD PLMT XTN PROSTH EA ADDL","code_information":[{"code":"34711","type":"CPT"}],"standard_charges":[{"minimum":298.25,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"}]}]},{"description":"TCAT DLVR ENHNCD FIXJ DEV","code_information":[{"code":"34712","type":"CPT"}],"standard_charges":[{"minimum":667.67,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.67,"methodology":"fee schedule"}]}]},{"description":"PERQ ACCESS  CLSR FEM ART","code_information":[{"code":"34713","type":"CPT"}],"standard_charges":[{"minimum":124.81,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"}]}]},{"description":"OPN FEM ART EXPOS CNDT CRTJ","code_information":[{"code":"34714","type":"CPT"}],"standard_charges":[{"minimum":273.58,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.58,"methodology":"fee schedule"}]}]},{"description":"OPN AX/SUBCLA ART EXPOS","code_information":[{"code":"34715","type":"CPT"}],"standard_charges":[{"minimum":302.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"}]}]},{"description":"OPN AX/SUBCLA ART EXPOS CNDT","code_information":[{"code":"34716","type":"CPT"}],"standard_charges":[{"minimum":378,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":378,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":378,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":378,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR A-ILIAC NDGFT","code_information":[{"code":"34717","type":"CPT"}],"standard_charges":[{"minimum":448.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"}]}]},{"description":"EVASC RPR N/A A-ILIAC NDGFT","code_information":[{"code":"34718","type":"CPT"}],"standard_charges":[{"minimum":1257.74,"maximum":6556.08,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6556.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4917.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4917.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1257.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1257.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1257.74,"methodology":"fee schedule"}]}]},{"description":"ENDOVAS ILIAC A DEVICE ADDON","code_information":[{"code":"34808","type":"CPT"}],"standard_charges":[{"minimum":205.27,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"}]}]},{"description":"OPN FEM ART EXPOS","code_information":[{"code":"34812","type":"CPT"}],"standard_charges":[{"minimum":208.85,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":937.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":702.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":702.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"}]}]},{"description":"FEMORAL ENDOVAS GRAFT ADD-ON","code_information":[{"code":"34813","type":"CPT"}],"standard_charges":[{"minimum":237.82,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.82,"methodology":"fee schedule"}]}]},{"description":"OPN ILIAC ART EXPOS","code_information":[{"code":"34820","type":"CPT"}],"standard_charges":[{"minimum":341.17,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":937.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":702.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":702.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"}]}]},{"description":"OPEN AORTIC TUBE PROSTH REPR","code_information":[{"code":"34830","type":"CPT"}],"standard_charges":[{"minimum":1792.73,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1792.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1792.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1792.73,"methodology":"fee schedule"}]}]},{"description":"OPEN AORTOILIAC PROSTH REPR","code_information":[{"code":"34831","type":"CPT"}],"standard_charges":[{"minimum":1960.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1960.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1960.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1960.46,"methodology":"fee schedule"}]}]},{"description":"OPEN AORTOFEMOR PROSTH REPR","code_information":[{"code":"34832","type":"CPT"}],"standard_charges":[{"minimum":1927.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1927.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1927.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1927.2,"methodology":"fee schedule"}]}]},{"description":"OPN ILAC ART EXPOS CNDT CRTJ","code_information":[{"code":"34833","type":"CPT"}],"standard_charges":[{"minimum":398.03,"maximum":5814,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":937.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":702.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":702.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.03,"methodology":"fee schedule"}]}]},{"description":"OPN BRACH ART EXPOS","code_information":[{"code":"34834","type":"CPT"}],"standard_charges":[{"minimum":130.89,"maximum":5814,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":937.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":702.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":702.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"}]}]},{"description":"PLNNING PT SPEC FENEST GRAFT","code_information":[{"code":"34839","type":"CPT"}],"standard_charges":[{"minimum":695.49,"maximum":927.17,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":927.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":695.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":695.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENDOVASC VISC AORTA 1 GRAFT","code_information":[{"code":"34841","type":"CPT"}],"standard_charges":[{"minimum":1518.87,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC VISC AORTA 2 GRAFT","code_information":[{"code":"34842","type":"CPT"}],"standard_charges":[{"minimum":1518.87,"maximum":6156.37,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6156.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4618.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4618.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC VISC AORTA 3 GRAFT","code_information":[{"code":"34843","type":"CPT"}],"standard_charges":[{"minimum":1640.39,"maximum":7182.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7182.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5387.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5387.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.39,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC VISC AORTA 4 GRAFT","code_information":[{"code":"34844","type":"CPT"}],"standard_charges":[{"minimum":1822.65,"maximum":7182.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7182.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5387.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5387.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.65,"methodology":"fee schedule"}]}]},{"description":"VISC  INFRAREN ABD 1 PROSTH","code_information":[{"code":"34845","type":"CPT"}],"standard_charges":[{"minimum":1518.87,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.87,"methodology":"fee schedule"}]}]},{"description":"VISC  INFRAREN ABD 2 PROSTH","code_information":[{"code":"34846","type":"CPT"}],"standard_charges":[{"minimum":1579.61,"maximum":6156.37,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6156.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4618.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4618.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1579.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1579.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1579.61,"methodology":"fee schedule"}]}]},{"description":"VISC  INFRAREN ABD 3 PROSTH","code_information":[{"code":"34847","type":"CPT"}],"standard_charges":[{"minimum":1579.61,"maximum":7182.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7182.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5387.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5387.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1579.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1579.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1579.61,"methodology":"fee schedule"}]}]},{"description":"VISC  INFRAREN ABD 4+ PROST","code_information":[{"code":"34848","type":"CPT"}],"standard_charges":[{"minimum":1640.39,"maximum":7182.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7182.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5387.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5387.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.39,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35001","type":"CPT"}],"standard_charges":[{"minimum":1144.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.02,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE NECK","code_information":[{"code":"35002","type":"CPT"}],"standard_charges":[{"minimum":1160.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35005","type":"CPT"}],"standard_charges":[{"minimum":1015.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35011","type":"CPT"}],"standard_charges":[{"minimum":1031.37,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1031.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1031.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1031.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE ARM","code_information":[{"code":"35013","type":"CPT"}],"standard_charges":[{"minimum":1294.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.57,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35021","type":"CPT"}],"standard_charges":[{"minimum":1289.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.92,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE CHEST","code_information":[{"code":"35022","type":"CPT"}],"standard_charges":[{"minimum":1474.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.45,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARM ARTERY","code_information":[{"code":"35045","type":"CPT"}],"standard_charges":[{"minimum":990.6,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35081","type":"CPT"}],"standard_charges":[{"minimum":1760.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1760.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1760.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1760.55,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE AORTA","code_information":[{"code":"35082","type":"CPT"}],"standard_charges":[{"minimum":2197.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197.91,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35091","type":"CPT"}],"standard_charges":[{"minimum":1808.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1808.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1808.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1808.11,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE AORTA","code_information":[{"code":"35092","type":"CPT"}],"standard_charges":[{"minimum":2638.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2638.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2638.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2638.14,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35102","type":"CPT"}],"standard_charges":[{"minimum":1914.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1914.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1914.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1914.32,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE AORTA","code_information":[{"code":"35103","type":"CPT"}],"standard_charges":[{"minimum":2252.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2252.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2252.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2252.99,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35111","type":"CPT"}],"standard_charges":[{"minimum":1352.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1352.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1352.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1352.87,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE SPLEEN","code_information":[{"code":"35112","type":"CPT"}],"standard_charges":[{"minimum":1662.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.56,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35121","type":"CPT"}],"standard_charges":[{"minimum":1607.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1607.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1607.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1607.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE BELLY","code_information":[{"code":"35122","type":"CPT"}],"standard_charges":[{"minimum":1922.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1922.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1922.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1922.91,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35131","type":"CPT"}],"standard_charges":[{"minimum":1406.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.51,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE GROIN","code_information":[{"code":"35132","type":"CPT"}],"standard_charges":[{"minimum":1662.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.56,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35141","type":"CPT"}],"standard_charges":[{"minimum":1111.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1111.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1111.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1111.83,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE THIGH","code_information":[{"code":"35142","type":"CPT"}],"standard_charges":[{"minimum":1343.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.21,"methodology":"fee schedule"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35151","type":"CPT"}],"standard_charges":[{"minimum":1264.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.18,"methodology":"fee schedule"}]}]},{"description":"REPAIR RUPTD POPLITEAL ART","code_information":[{"code":"35152","type":"CPT"}],"standard_charges":[{"minimum":1422.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1422.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1422.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1422.6,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35180","type":"CPT"}],"standard_charges":[{"minimum":801.42,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35182","type":"CPT"}],"standard_charges":[{"minimum":1839.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35184","type":"CPT"}],"standard_charges":[{"minimum":983.45,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":983.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":983.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":983.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35188","type":"CPT"}],"standard_charges":[{"minimum":1347.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1347.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1347.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1347.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35189","type":"CPT"}],"standard_charges":[{"minimum":1536.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1536.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1536.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1536.68,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35190","type":"CPT"}],"standard_charges":[{"minimum":774.96,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35201","type":"CPT"}],"standard_charges":[{"minimum":957.34,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35206","type":"CPT"}],"standard_charges":[{"minimum":813.58,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35207","type":"CPT"}],"standard_charges":[{"minimum":793.91,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35211","type":"CPT"}],"standard_charges":[{"minimum":1429.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1429.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1429.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1429.04,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35216","type":"CPT"}],"standard_charges":[{"minimum":2162.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2162.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2162.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2162.15,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35221","type":"CPT"}],"standard_charges":[{"minimum":1512.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.72,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35226","type":"CPT"}],"standard_charges":[{"minimum":749.9,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35231","type":"CPT"}],"standard_charges":[{"minimum":1293.5,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35236","type":"CPT"}],"standard_charges":[{"minimum":1024.22,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35241","type":"CPT"}],"standard_charges":[{"minimum":1468.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.38,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35246","type":"CPT"}],"standard_charges":[{"minimum":1596.4,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35251","type":"CPT"}],"standard_charges":[{"minimum":1781.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1781.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1781.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1781.65,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35256","type":"CPT"}],"standard_charges":[{"minimum":1032.44,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35261","type":"CPT"}],"standard_charges":[{"minimum":1000.61,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1000.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35266","type":"CPT"}],"standard_charges":[{"minimum":885.1,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35271","type":"CPT"}],"standard_charges":[{"minimum":1421.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35276","type":"CPT"}],"standard_charges":[{"minimum":1491.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1491.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1491.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1491.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35281","type":"CPT"}],"standard_charges":[{"minimum":1654.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1654.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1654.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1654.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35286","type":"CPT"}],"standard_charges":[{"minimum":945.54,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":945.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":945.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":945.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35301","type":"CPT"}],"standard_charges":[{"minimum":1149.74,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.74,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35302","type":"CPT"}],"standard_charges":[{"minimum":1137.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1137.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1137.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1137.58,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35303","type":"CPT"}],"standard_charges":[{"minimum":1246.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.65,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35304","type":"CPT"}],"standard_charges":[{"minimum":1297.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.79,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35305","type":"CPT"}],"standard_charges":[{"minimum":1248.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.44,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35306","type":"CPT"}],"standard_charges":[{"minimum":450.6,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35311","type":"CPT"}],"standard_charges":[{"minimum":1584.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1584.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1584.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1584.96,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35321","type":"CPT"}],"standard_charges":[{"minimum":916.93,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35331","type":"CPT"}],"standard_charges":[{"minimum":1480.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35341","type":"CPT"}],"standard_charges":[{"minimum":1411.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.87,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35351","type":"CPT"}],"standard_charges":[{"minimum":1307.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.81,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35355","type":"CPT"}],"standard_charges":[{"minimum":1046.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35361","type":"CPT"}],"standard_charges":[{"minimum":1549.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1549.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1549.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1549.55,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35363","type":"CPT"}],"standard_charges":[{"minimum":1651.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.48,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35371","type":"CPT"}],"standard_charges":[{"minimum":829.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.67,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35372","type":"CPT"}],"standard_charges":[{"minimum":993.82,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":993.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":993.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":993.82,"methodology":"fee schedule"}]}]},{"description":"REOPERATION CAROTID ADD-ON","code_information":[{"code":"35390","type":"CPT"}],"standard_charges":[{"minimum":160.93,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"}]}]},{"description":"ANGIOSCOPY","code_information":[{"code":"35400","type":"CPT"}],"standard_charges":[{"minimum":149.84,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"}]}]},{"description":"HARVEST VEIN FOR BYPASS","code_information":[{"code":"35500","type":"CPT"}],"standard_charges":[{"minimum":322.57,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.57,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT IPSILAT CAROTID","code_information":[{"code":"35501","type":"CPT"}],"standard_charges":[{"minimum":1484.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.11,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT SUBCLAV-CAROTID","code_information":[{"code":"35506","type":"CPT"}],"standard_charges":[{"minimum":1296,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT CAROTID-VERTBRL","code_information":[{"code":"35508","type":"CPT"}],"standard_charges":[{"minimum":1353.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1353.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1353.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1353.22,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT CONTRAL CAROTID","code_information":[{"code":"35509","type":"CPT"}],"standard_charges":[{"minimum":1435.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.12,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT CAROTID-BRCHIAL","code_information":[{"code":"35510","type":"CPT"}],"standard_charges":[{"minimum":1251.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1251.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1251.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1251.3,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT SUBCLAV-SUBCLAV","code_information":[{"code":"35511","type":"CPT"}],"standard_charges":[{"minimum":1140.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT SUBCLAV-BRCHIAL","code_information":[{"code":"35512","type":"CPT"}],"standard_charges":[{"minimum":1226.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1226.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1226.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1226.98,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT SUBCLAV-VERTBRL","code_information":[{"code":"35515","type":"CPT"}],"standard_charges":[{"minimum":1353.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1353.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1353.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1353.22,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT SUBCLAV-AXILARY","code_information":[{"code":"35516","type":"CPT"}],"standard_charges":[{"minimum":1241.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.65,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AXILLARY-AXILRY","code_information":[{"code":"35518","type":"CPT"}],"standard_charges":[{"minimum":1162.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.26,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AXILL-FEMORAL","code_information":[{"code":"35521","type":"CPT"}],"standard_charges":[{"minimum":1250.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1250.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1250.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1250.94,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AXILL-BRACHIAL","code_information":[{"code":"35522","type":"CPT"}],"standard_charges":[{"minimum":1190.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.51,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT BRCHL-ULNR-RDL","code_information":[{"code":"35523","type":"CPT"}],"standard_charges":[{"minimum":1252.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.37,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT BRACHIAL-BRCHL","code_information":[{"code":"35525","type":"CPT"}],"standard_charges":[{"minimum":1152.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.96,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AOR/CAROT/INNOM","code_information":[{"code":"35526","type":"CPT"}],"standard_charges":[{"minimum":1765.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1765.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1765.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1765.2,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AORCEL/AORMESEN","code_information":[{"code":"35531","type":"CPT"}],"standard_charges":[{"minimum":1982.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1982.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1982.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1982.63,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AXILL/FEM/FEM","code_information":[{"code":"35533","type":"CPT"}],"standard_charges":[{"minimum":1533.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT HEPATORENAL","code_information":[{"code":"35535","type":"CPT"}],"standard_charges":[{"minimum":1935.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1935.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1935.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1935.07,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT SPLENORENAL","code_information":[{"code":"35536","type":"CPT"}],"standard_charges":[{"minimum":1718.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1718.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1718.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1718.71,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AORTOILIAC","code_information":[{"code":"35537","type":"CPT"}],"standard_charges":[{"minimum":2119.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2119.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2119.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2119.24,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AORTOBI-ILIAC","code_information":[{"code":"35538","type":"CPT"}],"standard_charges":[{"minimum":2373.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2373.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2373.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2373.15,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AORTOFEMORAL","code_information":[{"code":"35539","type":"CPT"}],"standard_charges":[{"minimum":2227.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2227.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2227.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2227.6,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AORTBIFEMORAL","code_information":[{"code":"35540","type":"CPT"}],"standard_charges":[{"minimum":2481.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2481.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2481.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2481.86,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT FEM-POPLITEAL","code_information":[{"code":"35556","type":"CPT"}],"standard_charges":[{"minimum":1416.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.52,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT FEM-FEMORAL","code_information":[{"code":"35558","type":"CPT"}],"standard_charges":[{"minimum":1261.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1261.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1261.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1261.67,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AORTORENAL","code_information":[{"code":"35560","type":"CPT"}],"standard_charges":[{"minimum":1734.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1734.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1734.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1734.08,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT ILIOILIAC","code_information":[{"code":"35563","type":"CPT"}],"standard_charges":[{"minimum":1348.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.22,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT ILIOFEMORAL","code_information":[{"code":"35565","type":"CPT"}],"standard_charges":[{"minimum":1335.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1335.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1335.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1335.34,"methodology":"fee schedule"}]}]},{"description":"ART BYP FEM-ANT-POST TIB/PRL","code_information":[{"code":"35566","type":"CPT"}],"standard_charges":[{"minimum":1688.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1688.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1688.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1688.67,"methodology":"fee schedule"}]}]},{"description":"ART BYP TIBIAL-TIB/PERONEAL","code_information":[{"code":"35570","type":"CPT"}],"standard_charges":[{"minimum":1500.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1500.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1500.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1500.2,"methodology":"fee schedule"}]}]},{"description":"ART BYP POP-TIBL-PRL-OTHER","code_information":[{"code":"35571","type":"CPT"}],"standard_charges":[{"minimum":1345.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1345.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1345.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1345.71,"methodology":"fee schedule"}]}]},{"description":"HARVEST FEMOROPOPLITEAL VEIN","code_information":[{"code":"35572","type":"CPT"}],"standard_charges":[{"minimum":347.96,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.96,"methodology":"fee schedule"}]}]},{"description":"VEIN BYP GRFT FEM-POPLITEAL","code_information":[{"code":"35583","type":"CPT"}],"standard_charges":[{"minimum":1465.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1465.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1465.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1465.51,"methodology":"fee schedule"}]}]},{"description":"VEIN BYP FEM-TIBIAL PERONEAL","code_information":[{"code":"35585","type":"CPT"}],"standard_charges":[{"minimum":1696.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1696.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1696.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1696.89,"methodology":"fee schedule"}]}]},{"description":"VEIN BYP POP-TIBL PERONEAL","code_information":[{"code":"35587","type":"CPT"}],"standard_charges":[{"minimum":1356.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1356.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1356.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1356.8,"methodology":"fee schedule"}]}]},{"description":"HARVEST ART FOR CABG ADD-ON","code_information":[{"code":"35600","type":"CPT"}],"standard_charges":[{"minimum":189.18,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.18,"methodology":"fee schedule"}]}]},{"description":"ART BYP COMMON IPSI CAROTID","code_information":[{"code":"35601","type":"CPT"}],"standard_charges":[{"minimum":1424.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1424.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1424.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1424.75,"methodology":"fee schedule"}]}]},{"description":"ART BYP CAROTID-SUBCLAVIAN","code_information":[{"code":"35606","type":"CPT"}],"standard_charges":[{"minimum":1197.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1197.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1197.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1197.3,"methodology":"fee schedule"}]}]},{"description":"ART BYP SUBCLAV-SUBCLAVIAN","code_information":[{"code":"35612","type":"CPT"}],"standard_charges":[{"minimum":1066.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.06,"methodology":"fee schedule"}]}]},{"description":"ART BYP SUBCLAV-AXILLARY","code_information":[{"code":"35616","type":"CPT"}],"standard_charges":[{"minimum":1121.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1121.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1121.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1121.49,"methodology":"fee schedule"}]}]},{"description":"ART BYP AXILLARY-FEMORAL","code_information":[{"code":"35621","type":"CPT"}],"standard_charges":[{"minimum":1115.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.41,"methodology":"fee schedule"}]}]},{"description":"ART BYP AXILLARY-POP-TIBIAL","code_information":[{"code":"35623","type":"CPT"}],"standard_charges":[{"minimum":1337.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1337.85,"methodology":"fee schedule"}]}]},{"description":"ART BYP AORSUBCL/CAROT/INNOM","code_information":[{"code":"35626","type":"CPT"}],"standard_charges":[{"minimum":1617.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1617.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1617.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1617.86,"methodology":"fee schedule"}]}]},{"description":"ART BYP AOR-CELIAC-MSN-RENAL","code_information":[{"code":"35631","type":"CPT"}],"standard_charges":[{"minimum":1884.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1884.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1884.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1884.28,"methodology":"fee schedule"}]}]},{"description":"ART BYP ILIO-CELIAC","code_information":[{"code":"35632","type":"CPT"}],"standard_charges":[{"minimum":1837.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1837.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1837.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1837.08,"methodology":"fee schedule"}]}]},{"description":"ART BYP ILIO-MESENTERIC","code_information":[{"code":"35633","type":"CPT"}],"standard_charges":[{"minimum":2015.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2015.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2015.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2015.17,"methodology":"fee schedule"}]}]},{"description":"ART BYP ILIORENAL","code_information":[{"code":"35634","type":"CPT"}],"standard_charges":[{"minimum":1797.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1797.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1797.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1797.74,"methodology":"fee schedule"}]}]},{"description":"ART BYP SPENORENAL","code_information":[{"code":"35636","type":"CPT"}],"standard_charges":[{"minimum":1622.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1622.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1622.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1622.51,"methodology":"fee schedule"}]}]},{"description":"ART BYP AORTOILIAC","code_information":[{"code":"35637","type":"CPT"}],"standard_charges":[{"minimum":1686.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.88,"methodology":"fee schedule"}]}]},{"description":"ART BYP AORTOBI-ILIAC","code_information":[{"code":"35638","type":"CPT"}],"standard_charges":[{"minimum":1763.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1763.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1763.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1763.41,"methodology":"fee schedule"}]}]},{"description":"ART BYP CAROTID-VERTEBRAL","code_information":[{"code":"35642","type":"CPT"}],"standard_charges":[{"minimum":1008.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"}]}]},{"description":"ART BYP SUBCLAV-VERTEBRL","code_information":[{"code":"35645","type":"CPT"}],"standard_charges":[{"minimum":965.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.92,"methodology":"fee schedule"}]}]},{"description":"ART BYP AORTOBIFEMORAL","code_information":[{"code":"35646","type":"CPT"}],"standard_charges":[{"minimum":1733.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1733.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1733.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1733.37,"methodology":"fee schedule"}]}]},{"description":"ART BYP AORTOFEMORAL","code_information":[{"code":"35647","type":"CPT"}],"standard_charges":[{"minimum":1576.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1576.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1576.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1576.38,"methodology":"fee schedule"}]}]},{"description":"ART BYP AXILLARY-AXILLARY","code_information":[{"code":"35650","type":"CPT"}],"standard_charges":[{"minimum":1040.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"}]}]},{"description":"ART BYP AXILL-FEM-FEMORAL","code_information":[{"code":"35654","type":"CPT"}],"standard_charges":[{"minimum":1386.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.84,"methodology":"fee schedule"}]}]},{"description":"ART BYP FEMORAL-POPLITEAL","code_information":[{"code":"35656","type":"CPT"}],"standard_charges":[{"minimum":1091.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1091.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1091.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1091.09,"methodology":"fee schedule"}]}]},{"description":"ART BYP FEMORAL-FEMORAL","code_information":[{"code":"35661","type":"CPT"}],"standard_charges":[{"minimum":1102.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1102.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1102.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1102.18,"methodology":"fee schedule"}]}]},{"description":"ART BYP ILIOILIAC","code_information":[{"code":"35663","type":"CPT"}],"standard_charges":[{"minimum":1241.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.29,"methodology":"fee schedule"}]}]},{"description":"ART BYP ILIOFEMORAL","code_information":[{"code":"35665","type":"CPT"}],"standard_charges":[{"minimum":1195.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1195.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1195.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1195.16,"methodology":"fee schedule"}]}]},{"description":"ART BYP FEM-ANT-POST TIB/PRL","code_information":[{"code":"35666","type":"CPT"}],"standard_charges":[{"minimum":1310.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1310.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1310.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1310.67,"methodology":"fee schedule"}]}]},{"description":"ART BYP POP-TIBL-PRL-OTHER","code_information":[{"code":"35671","type":"CPT"}],"standard_charges":[{"minimum":1154.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1154.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1154.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1154.03,"methodology":"fee schedule"}]}]},{"description":"COMPOSITE BYP GRFT PROSVEIN","code_information":[{"code":"35681","type":"CPT"}],"standard_charges":[{"minimum":80.82,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"}]}]},{"description":"COMPOSITE BYP GRFT 2 VEINS","code_information":[{"code":"35682","type":"CPT"}],"standard_charges":[{"minimum":357.62,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.62,"methodology":"fee schedule"}]}]},{"description":"BYPASS GRAFT PATENCY/PATCH","code_information":[{"code":"35685","type":"CPT"}],"standard_charges":[{"minimum":200.27,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"}]}]},{"description":"BYPASS GRAFT/AV FIST PATENCY","code_information":[{"code":"35686","type":"CPT"}],"standard_charges":[{"minimum":162.72,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.72,"methodology":"fee schedule"}]}]},{"description":"ART TRNSPOSJ VERTBRL CAROTID","code_information":[{"code":"35691","type":"CPT"}],"standard_charges":[{"minimum":964.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":964.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":964.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":964.49,"methodology":"fee schedule"}]}]},{"description":"ART TRNSPOSJ SUBCLAVIAN","code_information":[{"code":"35693","type":"CPT"}],"standard_charges":[{"minimum":855.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.42,"methodology":"fee schedule"}]}]},{"description":"ART TRNSPOSJ SUBCLAV CAROTID","code_information":[{"code":"35694","type":"CPT"}],"standard_charges":[{"minimum":1007.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"}]}]},{"description":"ART TRNSPOSJ CAROTID SUBCLAV","code_information":[{"code":"35695","type":"CPT"}],"standard_charges":[{"minimum":1045.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.31,"methodology":"fee schedule"}]}]},{"description":"REIMPLANT ARTERY EACH","code_information":[{"code":"35697","type":"CPT"}],"standard_charges":[{"minimum":148.41,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"}]}]},{"description":"REOPERATION BYPASS GRAFT","code_information":[{"code":"35700","type":"CPT"}],"standard_charges":[{"minimum":153.42,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.42,"methodology":"fee schedule"}]}]},{"description":"EXPL N/FLWD SURG NECK ART","code_information":[{"code":"35701","type":"CPT"}],"standard_charges":[{"minimum":454.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.89,"methodology":"fee schedule"}]}]},{"description":"EXPL N/FLWD SURG UXTR ART","code_information":[{"code":"35702","type":"CPT"}],"standard_charges":[{"minimum":420.92,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"}]}]},{"description":"EXPL N/FLWD SURG LXTR ART","code_information":[{"code":"35703","type":"CPT"}],"standard_charges":[{"minimum":425.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.56,"methodology":"fee schedule"}]}]},{"description":"EXPLORE NECK VESSELS","code_information":[{"code":"35800","type":"CPT"}],"standard_charges":[{"minimum":762.8,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.8,"methodology":"fee schedule"}]}]},{"description":"EXPLORE CHEST VESSELS","code_information":[{"code":"35820","type":"CPT"}],"standard_charges":[{"minimum":2059.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2059.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2059.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2059.52,"methodology":"fee schedule"}]}]},{"description":"EXPLORE ABDOMINAL VESSELS","code_information":[{"code":"35840","type":"CPT"}],"standard_charges":[{"minimum":1258.81,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.81,"methodology":"fee schedule"}]}]},{"description":"EXPLORE LIMB VESSELS","code_information":[{"code":"35860","type":"CPT"}],"standard_charges":[{"minimum":862.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPAIR VESSEL GRAFT DEFECT","code_information":[{"code":"35870","type":"CPT"}],"standard_charges":[{"minimum":1270.97,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.97,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF CLOT IN GRAFT","code_information":[{"code":"35875","type":"CPT"}],"standard_charges":[{"minimum":603.66,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF CLOT IN GRAFT","code_information":[{"code":"35876","type":"CPT"}],"standard_charges":[{"minimum":959.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REVISE GRAFT W/VEIN","code_information":[{"code":"35879","type":"CPT"}],"standard_charges":[{"minimum":938.03,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REVISE GRAFT W/VEIN","code_information":[{"code":"35881","type":"CPT"}],"standard_charges":[{"minimum":1048.53,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REVISE GRAFT W/NONAUTO GRAFT","code_information":[{"code":"35883","type":"CPT"}],"standard_charges":[{"minimum":1216.26,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REVISE GRAFT W/VEIN","code_information":[{"code":"35884","type":"CPT"}],"standard_charges":[{"minimum":1260.96,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1260.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1260.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1260.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"EXCISION GRAFT NECK","code_information":[{"code":"35901","type":"CPT"}],"standard_charges":[{"minimum":489.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"}]}]},{"description":"EXCISION GRAFT EXTREMITY","code_information":[{"code":"35903","type":"CPT"}],"standard_charges":[{"minimum":578.62,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"EXCISION GRAFT THORAX","code_information":[{"code":"35905","type":"CPT"}],"standard_charges":[{"minimum":1709.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1709.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1709.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1709.05,"methodology":"fee schedule"}]}]},{"description":"EXCISION GRAFT ABDOMEN","code_information":[{"code":"35907","type":"CPT"}],"standard_charges":[{"minimum":1941.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1941.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1941.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1941.5,"methodology":"fee schedule"}]}]},{"description":"PLACE NEEDLE IN VEIN","code_information":[{"code":"36000","type":"CPT"}],"standard_charges":[{"minimum":9.66,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"}]}]},{"description":"PSEUDOANEURYSM INJECTION TRT","code_information":[{"code":"36002","type":"CPT"}],"standard_charges":[{"minimum":106.93,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":605.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":454.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":454.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"INJECTION EXT VENOGRAPHY","code_information":[{"code":"36005","type":"CPT"}],"standard_charges":[{"minimum":48.64,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":274.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":206.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":206.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.64,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN VEIN","code_information":[{"code":"36010","type":"CPT"}],"standard_charges":[{"minimum":110.86,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.86,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN VEIN","code_information":[{"code":"36011","type":"CPT"}],"standard_charges":[{"minimum":159.14,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN VEIN","code_information":[{"code":"36012","type":"CPT"}],"standard_charges":[{"minimum":177.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN ARTERY","code_information":[{"code":"36013","type":"CPT"}],"standard_charges":[{"minimum":128.74,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN ARTERY","code_information":[{"code":"36014","type":"CPT"}],"standard_charges":[{"minimum":154.49,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.49,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN ARTERY","code_information":[{"code":"36015","type":"CPT"}],"standard_charges":[{"minimum":175.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH ACCESS TO ARTERY","code_information":[{"code":"36100","type":"CPT"}],"standard_charges":[{"minimum":154.85,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.85,"methodology":"fee schedule"}]}]},{"description":"INTRO NDL ICATH UPR/LXTR ART","code_information":[{"code":"36140","type":"CPT"}],"standard_charges":[{"minimum":90.83,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH ACCESS TO AORTA","code_information":[{"code":"36160","type":"CPT"}],"standard_charges":[{"minimum":125.88,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.88,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN AORTA","code_information":[{"code":"36200","type":"CPT"}],"standard_charges":[{"minimum":141.62,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN ARTERY","code_information":[{"code":"36215","type":"CPT"}],"standard_charges":[{"minimum":217.79,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN ARTERY","code_information":[{"code":"36216","type":"CPT"}],"standard_charges":[{"minimum":277.87,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN ARTERY","code_information":[{"code":"36217","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.45,"methodology":"fee schedule"}]}]},{"description":"PLACE CATHETER IN ARTERY","code_information":[{"code":"36218","type":"CPT"}],"standard_charges":[{"minimum":53.64,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"}]}]},{"description":"PLACE CATH THORACIC AORTA","code_information":[{"code":"36221","type":"CPT"}],"standard_charges":[{"minimum":203.84,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"PLACE CATH CAROTID/INOM ART","code_information":[{"code":"36222","type":"CPT"}],"standard_charges":[{"minimum":292.53,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"PLACE CATH CAROTID/INOM ART","code_information":[{"code":"36223","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"PLACE CATH CAROTD ART","code_information":[{"code":"36224","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"PLACE CATH SUBCLAVIAN ART","code_information":[{"code":"36225","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"PLACE CATH VERTEBRAL ART","code_information":[{"code":"36226","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"PLACE CATH XTRNL CAROTID","code_information":[{"code":"36227","type":"CPT"}],"standard_charges":[{"minimum":124.09,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"}]}]},{"description":"PLACE CATH INTRACRANIAL ART","code_information":[{"code":"36228","type":"CPT"}],"standard_charges":[{"minimum":148.3,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.34,"methodology":"fee schedule"}]}]},{"description":"INS CATH ABD/L-EXT ART 1ST","code_information":[{"code":"36245","type":"CPT"}],"standard_charges":[{"minimum":240.32,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"}]}]},{"description":"INS CATH ABD/L-EXT ART 2ND","code_information":[{"code":"36246","type":"CPT"}],"standard_charges":[{"minimum":257.48,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.48,"methodology":"fee schedule"}]}]},{"description":"INS CATH ABD/L-EXT ART 3RD","code_information":[{"code":"36247","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.97,"methodology":"fee schedule"}]}]},{"description":"INS CATH ABD/L-EXT ART ADDL","code_information":[{"code":"36248","type":"CPT"}],"standard_charges":[{"minimum":49.35,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"}]}]},{"description":"INS CATH REN ART 1ST UNILAT","code_information":[{"code":"36251","type":"CPT"}],"standard_charges":[{"minimum":260.7,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INS CATH REN ART 1ST BILAT","code_information":[{"code":"36252","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INS CATH REN ART 2ND+ UNILAT","code_information":[{"code":"36253","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"INS CATH REN ART 2ND+ BILAT","code_information":[{"code":"36254","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF INFUSION PUMP","code_information":[{"code":"36260","type":"CPT"}],"standard_charges":[{"minimum":687.7,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REVISION OF INFUSION PUMP","code_information":[{"code":"36261","type":"CPT"}],"standard_charges":[{"minimum":433.43,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF INFUSION PUMP","code_information":[{"code":"36262","type":"CPT"}],"standard_charges":[{"minimum":331.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3917.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3995.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3956.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3975.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3878.84,"methodology":"fee schedule"}]}]},{"description":"VESSEL INJECTION PROCEDURE","code_information":[{"code":"36299","type":"CPT"}],"standard_charges":[{"minimum":1488,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BL DRAW < 3 YRS FEM/JUGULAR","code_information":[{"code":"36400","type":"CPT"}],"standard_charges":[{"minimum":19.31,"maximum":98.37,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":73.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":73.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"}]}]},{"description":"BL DRAW <3 YRS SCALP VEIN","code_information":[{"code":"36405","type":"CPT"}],"standard_charges":[{"minimum":15.38,"maximum":85.99,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"}]}]},{"description":"BL DRAW <3 YRS OTHER VEIN","code_information":[{"code":"36406","type":"CPT"}],"standard_charges":[{"minimum":9.3,"maximum":50.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"}]}]},{"description":"VENIPUNCTURE >3YR PHY SKILL","code_information":[{"code":"36410","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":601.55,"maximum":927.3,"gross_charge":1135,"discounted_cash":259.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":601.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":927.3,"methodology":"fee schedule"}]}]},{"description":"VENIPUNCTURE >3YR PHY SKILL","code_information":[{"code":"36410","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":9.66,"maximum":927.3,"gross_charge":1135,"discounted_cash":259.92,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":601.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":927.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"}]}]},{"description":"VENIPUNCTURE","code_information":[{"code":"36415","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":31.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"}]}]},{"description":"VENIPUNCTURE","code_information":[{"code":"36415","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.08,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"}]}]},{"description":"COLLECTION CAPILLAR BLOOD","code_information":[{"code":"36416","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"COLLECTION CAPILLAR BLOOD","code_information":[{"code":"36416","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":0.27,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"}]}]},{"description":"VENIPUNCTURE CUTDOWN < AGE 1","code_information":[{"code":"36420","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":322.77,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"}]}]},{"description":"VENIPUNCTURE CUTDOWN < AGE 1","code_information":[{"code":"36420","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":42.82,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"VENIPUNCTURE CUTDOWN > AGE 1","code_information":[{"code":"36425","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":799.77,"maximum":1232.86,"gross_charge":1509,"discounted_cash":345.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":799.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1232.86,"methodology":"fee schedule"}]}]},{"description":"VENIPUNCTURE CUTDOWN > AGE 1","code_information":[{"code":"36425","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":41.13,"maximum":1232.86,"gross_charge":1509,"discounted_cash":345.57,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":799.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1232.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"TRANSFUSION BLOOD/BLOOD COMP","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":531.06,"maximum":818.64,"gross_charge":1002,"discounted_cash":229.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":818.64,"methodology":"fee schedule"}]}]},{"description":"TRANSFUSION BLOOD/BLOOD COMP","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":43.99,"maximum":2053,"gross_charge":1002,"discounted_cash":229.46,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":876.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":818.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"BL PUSH TRANSFUSE 2 YR/<","code_information":[{"code":"36440","type":"CPT"}],"standard_charges":[{"minimum":52.21,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":876.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"BL EXCHANGE/TRANSFUSE NB","code_information":[{"code":"36450","type":"CPT"}],"standard_charges":[{"minimum":177.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":876.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"BL EXCHANGE/TRANSFUSE NON-NB","code_information":[{"code":"36455","type":"CPT"}],"standard_charges":[{"minimum":128.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":876.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"PRTL EXCHANGE TRANSFUSE NB","code_information":[{"code":"36456","type":"CPT"}],"standard_charges":[{"minimum":101.21,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":876.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":657.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"TRANSFUSION SERVICE FETAL","code_information":[{"code":"36460","type":"CPT"}],"standard_charges":[{"minimum":357.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"NJX NONCMPND SCLRSNT 1 VEIN","code_information":[{"code":"36465","type":"CPT"}],"standard_charges":[{"minimum":121.95,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"NJX NONCMPND SCLRSNT MLT VN","code_information":[{"code":"36466","type":"CPT"}],"standard_charges":[{"minimum":155.21,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"NJX SCLRSNT SPIDER VEINS","code_information":[{"code":"36468","type":"CPT"}],"standard_charges":[{"minimum":162.24,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"NJX SCLRSNT 1 INCMPTNT VEIN","code_information":[{"code":"36470","type":"CPT"}],"standard_charges":[{"minimum":38.98,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"NJX SCLRSNT MLT INCMPTNT VN","code_information":[{"code":"36471","type":"CPT"}],"standard_charges":[{"minimum":77.96,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"ENDOVENOUS MCHNCHEM 1ST VEIN","code_information":[{"code":"36473","type":"CPT"}],"standard_charges":[{"minimum":185.25,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"ENDOVENOUS MCHNCHEM ADD-ON","code_information":[{"code":"36474","type":"CPT"}],"standard_charges":[{"minimum":90.83,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"}]}]},{"description":"ENDOVENOUS RF 1ST VEIN","code_information":[{"code":"36475","type":"CPT"}],"standard_charges":[{"minimum":283.95,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"ENDOVENOUS RF VEIN ADD-ON","code_information":[{"code":"36476","type":"CPT"}],"standard_charges":[{"minimum":135.89,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.89,"methodology":"fee schedule"}]}]},{"description":"ENDOVENOUS LASER 1ST VEIN","code_information":[{"code":"36478","type":"CPT"}],"standard_charges":[{"minimum":284.31,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"ENDOVENOUS LASER VEIN ADDON","code_information":[{"code":"36479","type":"CPT"}],"standard_charges":[{"minimum":138.76,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CATHETER VEIN","code_information":[{"code":"36481","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.94,"methodology":"fee schedule"}]}]},{"description":"ENDOVEN THER CHEM ADHES 1ST","code_information":[{"code":"36482","type":"CPT"}],"standard_charges":[{"minimum":183.46,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":929.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":697.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":697.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"ENDOVEN THER CHEM ADHES SBSQ","code_information":[{"code":"36483","type":"CPT"}],"standard_charges":[{"minimum":90.12,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":348.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":348.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.12,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CATHETER VEIN","code_information":[{"code":"36500","type":"CPT"}],"standard_charges":[{"minimum":185.96,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CATHETER VEIN","code_information":[{"code":"36510","type":"CPT"}],"standard_charges":[{"minimum":55.43,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":235.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":235.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"}]}]},{"description":"APHERESIS WBC","code_information":[{"code":"36511","type":"CPT"}],"standard_charges":[{"minimum":115.51,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1764.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1799.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1782.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1790.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"}]}]},{"description":"APHERESIS RBC","code_information":[{"code":"36512","type":"CPT"}],"standard_charges":[{"minimum":110.15,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1764.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1799.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1782.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1790.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"}]}]},{"description":"APHERESIS PLATELETS","code_information":[{"code":"36513","type":"CPT"}],"standard_charges":[{"minimum":110.15,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"APHERESIS PLASMA","code_information":[{"code":"36514","type":"CPT"}],"standard_charges":[{"minimum":96.91,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1764.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1799.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1782.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1790.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"}]}]},{"description":"APHERESIS IMMUNOADS SLCTV","code_information":[{"code":"36516","type":"CPT"}],"standard_charges":[{"minimum":88.69,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5043.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5143.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5093.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5118.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"}]}]},{"description":"PHOTOPHERESIS","code_information":[{"code":"36522","type":"CPT"}],"standard_charges":[{"minimum":99.42,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2597.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1948.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1948.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5043.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5143.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5093.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5118.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"}]}]},{"description":"INSERT NON-TUNNEL CV CATH","code_information":[{"code":"36555","type":"CPT"}],"standard_charges":[{"minimum":87.62,"maximum":3455.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT NON-TUNNEL CV CATH","code_information":[{"code":"36556","type":"CPT"}],"standard_charges":[{"minimum":87.26,"maximum":3455.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36557","type":"CPT"}],"standard_charges":[{"minimum":333.66,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"INS TUNNEL CV CATH WO PORT>5YR","code_information":[{"code":"36558","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":6168.67,"maximum":9509.07,"gross_charge":11639,"discounted_cash":2665.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6168.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9509.07,"methodology":"fee schedule"}]}]},{"description":"INS TUNNEL CV CATH WO PORT>5YR","code_information":[{"code":"36558","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":267.5,"maximum":9509.07,"gross_charge":11639,"discounted_cash":2665.34,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6168.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9509.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36560","type":"CPT"}],"standard_charges":[{"minimum":398.74,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36561","type":"CPT"}],"standard_charges":[{"minimum":342.95,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36563","type":"CPT"}],"standard_charges":[{"minimum":373.71,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36565","type":"CPT"}],"standard_charges":[{"minimum":347.6,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36566","type":"CPT"}],"standard_charges":[{"minimum":368.7,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"INSJ PICC <5 YR W/O IMAGING","code_information":[{"code":"36568","type":"CPT"}],"standard_charges":[{"minimum":95.13,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"INSERT PICC WO P/P >5YR WO GDE","code_information":[{"code":"36569","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3364.44,"maximum":5186.32,"gross_charge":6348,"discounted_cash":1453.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3364.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5186.32,"methodology":"fee schedule"}]}]},{"description":"INSERT PICC WO P/P >5YR WO GDE","code_information":[{"code":"36569","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":97.63,"maximum":5186.32,"gross_charge":6348,"discounted_cash":1453.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3364.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5186.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"INSERT PICVAD CATH","code_information":[{"code":"36570","type":"CPT"}],"standard_charges":[{"minimum":346.17,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT PICVAD CATH","code_information":[{"code":"36571","type":"CPT"}],"standard_charges":[{"minimum":324,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":324,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":324,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":324,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSJ PICC RSI <5 YR","code_information":[{"code":"36572","type":"CPT"}],"standard_charges":[{"minimum":83.68,"maximum":2595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"INSJ PICC RSI 5 YR+","code_information":[{"code":"36573","type":"CPT"}],"standard_charges":[{"minimum":85.83,"maximum":4378,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4378,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4378,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"REPAIR CV CATH WO PUMP/PORT","code_information":[{"code":"36575","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1319.7,"maximum":2034.33,"gross_charge":2490,"discounted_cash":570.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1319.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2034.33,"methodology":"fee schedule"}]}]},{"description":"REPAIR CV CATH WO PUMP/PORT","code_information":[{"code":"36575","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":34.33,"maximum":2732.21,"gross_charge":2490,"discounted_cash":570.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1319.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2034.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"REPAIR TUNNELED CV CATH","code_information":[{"code":"36576","type":"CPT"}],"standard_charges":[{"minimum":189.54,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"REPLACE TUNNELED CV CATH","code_information":[{"code":"36578","type":"CPT"}],"standard_charges":[{"minimum":210.64,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPLACE CVAD CATH","code_information":[{"code":"36580","type":"CPT"}],"standard_charges":[{"minimum":66.87,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"REPLACE TUNNELED CV CATH","code_information":[{"code":"36581","type":"CPT"}],"standard_charges":[{"minimum":188.82,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPLACE TUNNELED CV CATH","code_information":[{"code":"36582","type":"CPT"}],"standard_charges":[{"minimum":296.46,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REPLACE TUNNELED CV CATH","code_information":[{"code":"36583","type":"CPT"}],"standard_charges":[{"minimum":341.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REPLACE PICC WO PORT W GDE","code_information":[{"code":"36584","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3364.44,"maximum":5186.32,"gross_charge":6348,"discounted_cash":1453.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3364.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5186.32,"methodology":"fee schedule"}]}]},{"description":"REPLACE PICC WO PORT W GDE","code_information":[{"code":"36584","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":60.08,"maximum":5186.32,"gross_charge":6348,"discounted_cash":1453.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3364.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5186.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"REPLACE PICVAD CATH","code_information":[{"code":"36585","type":"CPT"}],"standard_charges":[{"minimum":288.95,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REMOVAL TUNNELED CV CATH","code_information":[{"code":"36589","type":"CPT"}],"standard_charges":[{"minimum":141.26,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"REMOVAL TUNNELED CV CATH","code_information":[{"code":"36590","type":"CPT"}],"standard_charges":[{"minimum":196.33,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"BLOOD COLLECTION VAD","code_information":[{"code":"36591","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":208.82,"maximum":321.9,"gross_charge":394,"discounted_cash":90.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":208.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":321.9,"methodology":"fee schedule"}]}]},{"description":"BLOOD COLLECTION VAD","code_information":[{"code":"36591","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":28.97,"maximum":321.9,"gross_charge":394,"discounted_cash":90.23,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":89.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":89.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":208.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":321.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"BLOOD COLLECTION PICC","code_information":[{"code":"36592","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":159.53,"maximum":245.92,"gross_charge":301,"discounted_cash":68.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"}]}]},{"description":"BLOOD COLLECTION PICC","code_information":[{"code":"36592","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":31.47,"maximum":245.92,"gross_charge":301,"discounted_cash":68.93,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"VASC ACCES THROMBL DECLOT","code_information":[{"code":"36593","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":566.04,"maximum":872.56,"gross_charge":1068,"discounted_cash":244.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":566.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":872.56,"methodology":"fee schedule"}]}]},{"description":"VASC ACCES THROMBL DECLOT","code_information":[{"code":"36593","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":36.12,"maximum":872.56,"gross_charge":1068,"discounted_cash":244.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":640.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":480.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":480.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":566.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":872.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":364.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":360.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":362.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"}]}]},{"description":"MECH REMOV TUNNELED CV CATH","code_information":[{"code":"36595","type":"CPT"}],"standard_charges":[{"minimum":185.96,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"MECH REMOV TUNNELED CV CATH","code_information":[{"code":"36596","type":"CPT"}],"standard_charges":[{"minimum":46.49,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"REPOSITION VENOUS CATHETER","code_information":[{"code":"36597","type":"CPT"}],"standard_charges":[{"minimum":61.87,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"INJ W/FLUOR EVAL CV DEVICE","code_information":[{"code":"36598","type":"CPT"}],"standard_charges":[{"minimum":36.48,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":682.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":512.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":512.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":191,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":226.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":231.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":229.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":230.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"}]}]},{"description":"ARTERIAL PUNCTURE","code_information":[{"code":"36600","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":295.21,"maximum":455.07,"gross_charge":557,"discounted_cash":127.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":295.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":455.07,"methodology":"fee schedule"}]}]},{"description":"ARTERIAL PUNCTURE","code_information":[{"code":"36600","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":15.38,"maximum":455.07,"gross_charge":557,"discounted_cash":127.56,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":295.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":455.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"ARTERIAL CATH/CANN PERC","code_information":[{"code":"36620","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":231.61,"maximum":357.03,"gross_charge":437,"discounted_cash":100.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":231.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":357.03,"methodology":"fee schedule"}]}]},{"description":"ARTERIAL CATH/CANN PERC","code_information":[{"code":"36620","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":45.77,"maximum":2040.26,"gross_charge":437,"discounted_cash":100.08,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":231.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":357.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"}]}]},{"description":"INSERTION CATHETER ARTERY","code_information":[{"code":"36625","type":"CPT"}],"standard_charges":[{"minimum":108.72,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":191,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.72,"methodology":"fee schedule"}]}]},{"description":"INSERTION CATHETER ARTERY","code_information":[{"code":"36640","type":"CPT"}],"standard_charges":[{"minimum":123.38,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERTION CATHETER ARTERY","code_information":[{"code":"36660","type":"CPT"}],"standard_charges":[{"minimum":70.81,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"}]}]},{"description":"INSERT NEEDLE BONE CAVITY","code_information":[{"code":"36680","type":"CPT"}],"standard_charges":[{"minimum":61.87,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CANNULA","code_information":[{"code":"36800","type":"CPT"}],"standard_charges":[{"minimum":125.17,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CANNULA","code_information":[{"code":"36810","type":"CPT"}],"standard_charges":[{"minimum":217.43,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CANNULA","code_information":[{"code":"36815","type":"CPT"}],"standard_charges":[{"minimum":138.04,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"AV FUSE UPPR ARM CEPHALIC","code_information":[{"code":"36818","type":"CPT"}],"standard_charges":[{"minimum":704.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"AV FUSE UPPR ARM BASILIC","code_information":[{"code":"36819","type":"CPT"}],"standard_charges":[{"minimum":745.63,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"AV FUSION/FOREARM VEIN","code_information":[{"code":"36820","type":"CPT"}],"standard_charges":[{"minimum":741.7,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"AV FUSION DIRECT ANY SITE","code_information":[{"code":"36821","type":"CPT"}],"standard_charges":[{"minimum":674.11,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CANNULA(S)","code_information":[{"code":"36823","type":"CPT"}],"standard_charges":[{"minimum":1461.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.94,"methodology":"fee schedule"}]}]},{"description":"ARTERY-VEIN AUTOGRAFT","code_information":[{"code":"36825","type":"CPT"}],"standard_charges":[{"minimum":810.36,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":810.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":810.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":810.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"ARTERY-VEIN NONAUTOGRAFT","code_information":[{"code":"36830","type":"CPT"}],"standard_charges":[{"minimum":680.55,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"OPEN THROMBECT AV FISTULA","code_information":[{"code":"36831","type":"CPT"}],"standard_charges":[{"minimum":630.48,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"AV FISTULA REVISION OPEN","code_information":[{"code":"36832","type":"CPT"}],"standard_charges":[{"minimum":772.81,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"AV FISTULA REVISION","code_information":[{"code":"36833","type":"CPT"}],"standard_charges":[{"minimum":823.95,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"ARTERY TO VEIN SHUNT","code_information":[{"code":"36835","type":"CPT"}],"standard_charges":[{"minimum":501.02,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"DIST REVAS LIGATION HEMO","code_information":[{"code":"36838","type":"CPT"}],"standard_charges":[{"minimum":1160.47,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"EXTERNAL CANNULA DECLOTTING","code_information":[{"code":"36860","type":"CPT"}],"standard_charges":[{"minimum":113.36,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"CANNULA DECLOTTING","code_information":[{"code":"36861","type":"CPT"}],"standard_charges":[{"minimum":141.97,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"INTRO NDL/CATH DIALY CIRCUIT","code_information":[{"code":"36901","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2262.57,"maximum":3487.78,"gross_charge":4269,"discounted_cash":977.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2262.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3487.78,"methodology":"fee schedule"}]}]},{"description":"INTRO NDL/CATH DIALY CIRCUIT","code_information":[{"code":"36901","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":171.66,"maximum":3487.78,"gross_charge":4269,"discounted_cash":977.61,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2262.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3487.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1672.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1705.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1688.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1697.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1655.69,"methodology":"fee schedule"}]}]},{"description":"INTRO CATH DIALYSIS CIRCUIT","code_information":[{"code":"36902","type":"CPT"}],"standard_charges":[{"minimum":244.97,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6137.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6259.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6198.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6228.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"}]}]},{"description":"INTRO CATH DIALYSIS CIRCUIT","code_information":[{"code":"36903","type":"CPT"}],"standard_charges":[{"minimum":321.86,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"THRMBC/NFS DIALYSIS CIRCUIT","code_information":[{"code":"36904","type":"CPT"}],"standard_charges":[{"minimum":375.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6137.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6259.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6198.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6228.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"}]}]},{"description":"THRMBC/NFS DIALYSIS CIRCUIT","code_information":[{"code":"36905","type":"CPT"}],"standard_charges":[{"minimum":451.31,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"THRMBC/NFS DIALYSIS CIRCUIT","code_information":[{"code":"36906","type":"CPT"}],"standard_charges":[{"minimum":521.05,"maximum":19712.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19330.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19521.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19617.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"}]}]},{"description":"BALO ANGIOP CTR DIALYSIS SEG","code_information":[{"code":"36907","type":"CPT"}],"standard_charges":[{"minimum":148.77,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"}]}]},{"description":"STENT PLMT CTR DIALYSIS SEG","code_information":[{"code":"36908","type":"CPT"}],"standard_charges":[{"minimum":210.99,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"}]}]},{"description":"DIALYSIS CIRCUIT EMBOLJ","code_information":[{"code":"36909","type":"CPT"}],"standard_charges":[{"minimum":204.91,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CIRCULATION","code_information":[{"code":"37140","type":"CPT"}],"standard_charges":[{"minimum":2407.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2407.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2407.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2407.48,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CIRCULATION","code_information":[{"code":"37145","type":"CPT"}],"standard_charges":[{"minimum":2234.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CIRCULATION","code_information":[{"code":"37160","type":"CPT"}],"standard_charges":[{"minimum":2294.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2294.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2294.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2294.47,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CIRCULATION","code_information":[{"code":"37180","type":"CPT"}],"standard_charges":[{"minimum":2205.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2205.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2205.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2205.42,"methodology":"fee schedule"}]}]},{"description":"SPLICE SPLEEN/KIDNEY VEINS","code_information":[{"code":"37181","type":"CPT"}],"standard_charges":[{"minimum":2407.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2407.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2407.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2407.48,"methodology":"fee schedule"}]}]},{"description":"INSERT HEPATIC SHUNT (TIPS)","code_information":[{"code":"37182","type":"CPT"}],"standard_charges":[{"minimum":831.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.46,"methodology":"fee schedule"}]}]},{"description":"REMOVE HEPATIC SHUNT (TIPS)","code_information":[{"code":"37183","type":"CPT"}],"standard_charges":[{"minimum":381.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6137.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6259.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6198.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6228.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"}]}]},{"description":"PRIM ART M-THRMBC 1ST VSL","code_information":[{"code":"37184","type":"CPT"}],"standard_charges":[{"minimum":438.44,"maximum":19712.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19330.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19521.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19617.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"}]}]},{"description":"PRIM ART M-THRMBC SBSQ VSL","code_information":[{"code":"37185","type":"CPT"}],"standard_charges":[{"minimum":165.58,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"}]}]},{"description":"SEC ART THROMBECTOMY ADD-ON","code_information":[{"code":"37186","type":"CPT"}],"standard_charges":[{"minimum":247.47,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"}]}]},{"description":"VENOUS MECH THROMBECTOMY","code_information":[{"code":"37187","type":"CPT"}],"standard_charges":[{"minimum":400.53,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"VEN MECHNL THRMBC REPEAT TX","code_information":[{"code":"37188","type":"CPT"}],"standard_charges":[{"minimum":286.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INS ENDOVAS VENA CAVA FILTR","code_information":[{"code":"37191","type":"CPT"}],"standard_charges":[{"minimum":224.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REDO ENDOVAS VENA CAVA FILTR","code_information":[{"code":"37192","type":"CPT"}],"standard_charges":[{"minimum":349.03,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REM ENDOVAS VENA CAVA FILTER","code_information":[{"code":"37193","type":"CPT"}],"standard_charges":[{"minimum":353.68,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"THROMBOLYTIC THERAPY STROKE","code_information":[{"code":"37195","type":"CPT"}],"standard_charges":[{"minimum":299.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":364.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":360.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":362.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE INTRVAS FOREIGN BODY","code_information":[{"code":"37197","type":"CPT"}],"standard_charges":[{"minimum":306.48,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"TRANSCATHETER BIOPSY","code_information":[{"code":"37200","type":"CPT"}],"standard_charges":[{"minimum":219.22,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"THROMBOLYTIC ART THERAPY","code_information":[{"code":"37211","type":"CPT"}],"standard_charges":[{"minimum":393.74,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"THROMBOLYTIC VENOUS THERAPY","code_information":[{"code":"37212","type":"CPT"}],"standard_charges":[{"minimum":343.67,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"THROMBLYTIC ART/VEN THERAPY","code_information":[{"code":"37213","type":"CPT"}],"standard_charges":[{"minimum":234.95,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"CESSJ THERAPY CATH REMOVAL","code_information":[{"code":"37214","type":"CPT"}],"standard_charges":[{"minimum":124.09,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"TRANSCATH STENT CCA W/EPS","code_information":[{"code":"37215","type":"CPT"}],"standard_charges":[{"minimum":1008.48,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"}]}]},{"description":"TRANSCATH STENT CCA W/O EPS","code_information":[{"code":"37216","type":"CPT"}],"standard_charges":[{"minimum":1025.65,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.65,"methodology":"fee schedule"}]}]},{"description":"STENT PLACEMT RETRO CAROTID","code_information":[{"code":"37217","type":"CPT"}],"standard_charges":[{"minimum":1097.88,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.88,"methodology":"fee schedule"}]}]},{"description":"STENT PLACEMT ANTE CAROTID","code_information":[{"code":"37218","type":"CPT"}],"standard_charges":[{"minimum":845.05,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"}]}]},{"description":"ILIAC REVASC","code_information":[{"code":"37220","type":"CPT"}],"standard_charges":[{"minimum":405.54,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6137.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6259.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6198.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6228.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"}]}]},{"description":"ILIAC REVASC W/STENT","code_information":[{"code":"37221","type":"CPT"}],"standard_charges":[{"minimum":499.23,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"ILIAC REVASC ADD-ON","code_information":[{"code":"37222","type":"CPT"}],"standard_charges":[{"minimum":187.39,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.39,"methodology":"fee schedule"}]}]},{"description":"ILIAC REVASC W/STENT ADD-ON","code_information":[{"code":"37223","type":"CPT"}],"standard_charges":[{"minimum":214.21,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"}]}]},{"description":"FEM/POPL REVAS W/TLA","code_information":[{"code":"37224","type":"CPT"}],"standard_charges":[{"minimum":450.24,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6137.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6259.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6198.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6228.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"}]}]},{"description":"FEM/POPL REVAS W/ATHER","code_information":[{"code":"37225","type":"CPT"}],"standard_charges":[{"minimum":606.52,"maximum":19712.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19330.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19521.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19617.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"}]}]},{"description":"FEM/POPL REVASC W/STENT","code_information":[{"code":"37226","type":"CPT"}],"standard_charges":[{"minimum":525.34,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"FEM/POPL REVASC STNT  ATHER","code_information":[{"code":"37227","type":"CPT"}],"standard_charges":[{"minimum":725.6,"maximum":19712.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19330.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19521.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19617.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"}]}]},{"description":"TIB/PER REVASC W/TLA","code_information":[{"code":"37228","type":"CPT"}],"standard_charges":[{"minimum":547.87,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"TIB/PER REVASC W/ATHER","code_information":[{"code":"37229","type":"CPT"}],"standard_charges":[{"minimum":702.72,"maximum":19712.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19330.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19521.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19617.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"}]}]},{"description":"TIB/PER REVASC W/STENT","code_information":[{"code":"37230","type":"CPT"}],"standard_charges":[{"minimum":702.36,"maximum":19712.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19330.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19521.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19617.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"}]}]},{"description":"TIB/PER REVASC STENT  ATHER","code_information":[{"code":"37231","type":"CPT"}],"standard_charges":[{"minimum":745.99,"maximum":19712.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19330.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19521.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19617.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"}]}]},{"description":"TIB/PER REVASC ADD-ON","code_information":[{"code":"37232","type":"CPT"}],"standard_charges":[{"minimum":202.05,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.05,"methodology":"fee schedule"}]}]},{"description":"TIBPER REVASC W/ATHER ADD-ON","code_information":[{"code":"37233","type":"CPT"}],"standard_charges":[{"minimum":326.86,"maximum":4419,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"}]}]},{"description":"REVSC OPN/PRQ TIB/PERO STENT","code_information":[{"code":"37234","type":"CPT"}],"standard_charges":[{"minimum":285.02,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"}]}]},{"description":"TIB/PER REVASC STNT  ATHER","code_information":[{"code":"37235","type":"CPT"}],"standard_charges":[{"minimum":374.78,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.78,"methodology":"fee schedule"}]}]},{"description":"OPEN/PERQ PLACE STENT 1ST","code_information":[{"code":"37236","type":"CPT"}],"standard_charges":[{"minimum":447.38,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"OPEN/PERQ PLACE STENT EA ADD","code_information":[{"code":"37237","type":"CPT"}],"standard_charges":[{"minimum":214.21,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"}]}]},{"description":"OPEN/PERQ PLACE STENT SAME","code_information":[{"code":"37238","type":"CPT"}],"standard_charges":[{"minimum":311.84,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"OPEN/PERQ PLACE STENT EA ADD","code_information":[{"code":"37239","type":"CPT"}],"standard_charges":[{"minimum":152.7,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"}]}]},{"description":"VASC EMBOLIZE/OCCLUDE VENOUS","code_information":[{"code":"37241","type":"CPT"}],"standard_charges":[{"minimum":435.58,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"VASC EMBOLIZE/OCCLUDE ARTERY","code_information":[{"code":"37242","type":"CPT"}],"standard_charges":[{"minimum":484.57,"maximum":19712.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19330.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19521.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19617.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19138.63,"methodology":"fee schedule"}]}]},{"description":"VASC EMBOLIZE/OCCLUDE ORGAN","code_information":[{"code":"37243","type":"CPT"}],"standard_charges":[{"minimum":572.19,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"VASC EMBOLIZE/OCCLUDE BLEED","code_information":[{"code":"37244","type":"CPT"}],"standard_charges":[{"minimum":674.11,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"TRLUML BALO ANGIOP 1ST ART","code_information":[{"code":"37246","type":"CPT"}],"standard_charges":[{"minimum":354.04,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6137.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6259.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6198.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6228.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"}]}]},{"description":"TRLUML BALO ANGIOP ADDL ART","code_information":[{"code":"37247","type":"CPT"}],"standard_charges":[{"minimum":176.31,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.31,"methodology":"fee schedule"}]}]},{"description":"TRLUML BALO ANGIOP 1ST VEIN","code_information":[{"code":"37248","type":"CPT"}],"standard_charges":[{"minimum":302.9,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6137.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6259.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6198.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6228.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6076.79,"methodology":"fee schedule"}]}]},{"description":"TRLUML BALO ANGIOP ADDL VEIN","code_information":[{"code":"37249","type":"CPT"}],"standard_charges":[{"minimum":148.05,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"}]}]},{"description":"INTRVASC US NONCORONARY 1ST","code_information":[{"code":"37252","type":"CPT"}],"standard_charges":[{"minimum":90.48,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"}]}]},{"description":"INTRVASC US NONCORONARY ADDL","code_information":[{"code":"37253","type":"CPT"}],"standard_charges":[{"minimum":71.88,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":510.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":382.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":382.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY LIGATE PERF VEINS","code_information":[{"code":"37500","type":"CPT"}],"standard_charges":[{"minimum":645.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":645.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"VASCULAR ENDOSCOPY PROCEDURE","code_information":[{"code":"37501","type":"CPT"}],"standard_charges":[{"minimum":402.49,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1563.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1173.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1173.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF NECK VEIN","code_information":[{"code":"37565","type":"CPT"}],"standard_charges":[{"minimum":757.79,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF NECK ARTERY","code_information":[{"code":"37600","type":"CPT"}],"standard_charges":[{"minimum":781.04,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF NECK ARTERY","code_information":[{"code":"37605","type":"CPT"}],"standard_charges":[{"minimum":754.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF NECK ARTERY","code_information":[{"code":"37606","type":"CPT"}],"standard_charges":[{"minimum":772.45,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF A-V FISTULA","code_information":[{"code":"37607","type":"CPT"}],"standard_charges":[{"minimum":385.15,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"TEMPORAL ARTERY PROCEDURE","code_information":[{"code":"37609","type":"CPT"}],"standard_charges":[{"minimum":213.14,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF NECK ARTERY","code_information":[{"code":"37615","type":"CPT"}],"standard_charges":[{"minimum":538.93,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF CHEST ARTERY","code_information":[{"code":"37616","type":"CPT"}],"standard_charges":[{"minimum":1165.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.12,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF ABDOMEN ARTERY","code_information":[{"code":"37617","type":"CPT"}],"standard_charges":[{"minimum":1368.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.24,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF EXTREMITY ARTERY","code_information":[{"code":"37618","type":"CPT"}],"standard_charges":[{"minimum":408.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.04,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF INF VENA CAVA","code_information":[{"code":"37619","type":"CPT"}],"standard_charges":[{"minimum":1789.52,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1789.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1789.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1789.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"REVISION OF MAJOR VEIN","code_information":[{"code":"37650","type":"CPT"}],"standard_charges":[{"minimum":471.34,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":471.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":471.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":471.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REVISION OF MAJOR VEIN","code_information":[{"code":"37660","type":"CPT"}],"standard_charges":[{"minimum":1366.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.1,"methodology":"fee schedule"}]}]},{"description":"REVISE LEG VEIN","code_information":[{"code":"37700","type":"CPT"}],"standard_charges":[{"minimum":252.48,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATE/STRIP SHORT LEG VEIN","code_information":[{"code":"37718","type":"CPT"}],"standard_charges":[{"minimum":403.75,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATE/STRIP LONG LEG VEIN","code_information":[{"code":"37722","type":"CPT"}],"standard_charges":[{"minimum":473.84,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LEG VEINS/LESION","code_information":[{"code":"37735","type":"CPT"}],"standard_charges":[{"minimum":596.86,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATE LEG VEINS RADICAL","code_information":[{"code":"37760","type":"CPT"}],"standard_charges":[{"minimum":590.78,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":590.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":590.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":590.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATE LEG VEINS OPEN","code_information":[{"code":"37761","type":"CPT"}],"standard_charges":[{"minimum":552.88,"maximum":3455.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"STAB PHLEB VEINS XTR 10-20","code_information":[{"code":"37765","type":"CPT"}],"standard_charges":[{"minimum":277.87,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"PHLEB VEINS - EXTREM 20+","code_information":[{"code":"37766","type":"CPT"}],"standard_charges":[{"minimum":340.45,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REVISION OF LEG VEIN","code_information":[{"code":"37780","type":"CPT"}],"standard_charges":[{"minimum":243.54,"maximum":3455.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"LIGATE/DIVIDE/EXCISE VEIN","code_information":[{"code":"37785","type":"CPT"}],"standard_charges":[{"minimum":263.56,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"REVASCULARIZATION PENIS","code_information":[{"code":"37788","type":"CPT"}],"standard_charges":[{"minimum":1316.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.03,"methodology":"fee schedule"}]}]},{"description":"PENILE VENOUS OCCLUSION","code_information":[{"code":"37790","type":"CPT"}],"standard_charges":[{"minimum":509.96,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":509.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":509.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":509.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"VASCULAR SURGERY PROCEDURE","code_information":[{"code":"37799","type":"CPT"}],"standard_charges":[{"minimum":402.49,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":665.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":678.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":672.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":675.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":658.95,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SPLEEN TOTAL","code_information":[{"code":"38100","type":"CPT"}],"standard_charges":[{"minimum":1198.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1198.37,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SPLEEN PARTIAL","code_information":[{"code":"38101","type":"CPT"}],"standard_charges":[{"minimum":1212.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.32,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SPLEEN TOTAL","code_information":[{"code":"38102","type":"CPT"}],"standard_charges":[{"minimum":271.07,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.07,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF RUPTURED SPLEEN","code_information":[{"code":"38115","type":"CPT"}],"standard_charges":[{"minimum":1344.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY SPLENECTOMY","code_information":[{"code":"38120","type":"CPT"}],"standard_charges":[{"minimum":1106.82,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC SPLEEN","code_information":[{"code":"38129","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR SPLEEN X-RAY","code_information":[{"code":"38200","type":"CPT"}],"standard_charges":[{"minimum":134.46,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"BL DONOR SEARCH MANAGEMENT","code_information":[{"code":"38204","type":"CPT"}],"standard_charges":[{"minimum":105.14,"maximum":532.92,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":399.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":399.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"}]}]},{"description":"HARVEST ALLOGENEIC STEM CELL","code_information":[{"code":"38205","type":"CPT"}],"standard_charges":[{"minimum":87.62,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.62,"methodology":"fee schedule"}]}]},{"description":"HARVEST AUTO STEM CELLS","code_information":[{"code":"38206","type":"CPT"}],"standard_charges":[{"minimum":85.83,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1764.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1799.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1782.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1790.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"}]}]},{"description":"CRYOPRESERVE STEM CELLS","code_information":[{"code":"38207","type":"CPT"}],"standard_charges":[{"minimum":46.85,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":261.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"THAW PRESERVED STEM CELLS","code_information":[{"code":"38208","type":"CPT"}],"standard_charges":[{"minimum":29.68,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":125.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":125.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"WASH HARVEST STEM CELLS","code_information":[{"code":"38209","type":"CPT"}],"standard_charges":[{"minimum":12.16,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"T-CELL DEPLETION OF HARVEST","code_information":[{"code":"38210","type":"CPT"}],"standard_charges":[{"minimum":82.25,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1582.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1186.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1186.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"TUMOR CELL DEPLETE OF HARVST","code_information":[{"code":"38211","type":"CPT"}],"standard_charges":[{"minimum":74.38,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":419.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":314.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":314.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"RBC DEPLETION OF HARVEST","code_information":[{"code":"38212","type":"CPT"}],"standard_charges":[{"minimum":49.35,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":278.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":208.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":208.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"PLATELET DEPLETE OF HARVEST","code_information":[{"code":"38213","type":"CPT"}],"standard_charges":[{"minimum":12.16,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"VOLUME DEPLETE OF HARVEST","code_information":[{"code":"38214","type":"CPT"}],"standard_charges":[{"minimum":42.2,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":178.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":178.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"HARVEST STEM CELL CONCENTRTE","code_information":[{"code":"38215","type":"CPT"}],"standard_charges":[{"minimum":49.35,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":278.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":208.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":208.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"DX BONE MARROW ASPIRATIONS","code_information":[{"code":"38220","type":"CPT"}],"standard_charges":[{"minimum":70.09,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DX BONE MARROW BIOPSIES","code_information":[{"code":"38221","type":"CPT"}],"standard_charges":[{"minimum":73.31,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DX BONE MARROW BX  ASPIR","code_information":[{"code":"38222","type":"CPT"}],"standard_charges":[{"minimum":78.32,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"BONE MARROW HARVEST ALLOGEN","code_information":[{"code":"38230","type":"CPT"}],"standard_charges":[{"minimum":210.64,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1764.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1799.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1782.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1790.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"}]}]},{"description":"BONE MARROW HARVEST AUTOLOG","code_information":[{"code":"38232","type":"CPT"}],"standard_charges":[{"minimum":196.69,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5043.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5143.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5093.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5118.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4993.55,"methodology":"fee schedule"}]}]},{"description":"TRANSPLT ALLO HCT/DONOR","code_information":[{"code":"38240","type":"CPT"}],"standard_charges":[{"minimum":252.12,"maximum":64926.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63035.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63665.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":64926.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64295.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63035.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63035.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63035.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64610.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63035.08,"methodology":"fee schedule"}]}]},{"description":"TRANSPLT AUTOL HCT/DONOR","code_information":[{"code":"38241","type":"CPT"}],"standard_charges":[{"minimum":186.32,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1764.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1799.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1782.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1790.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"}]}]},{"description":"TRANSPLT ALLO LYMPHOCYTES","code_information":[{"code":"38242","type":"CPT"}],"standard_charges":[{"minimum":131.6,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1764.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1799.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1782.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1790.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"}]}]},{"description":"TRANSPLJ HEMATOPOIETIC BOOST","code_information":[{"code":"38243","type":"CPT"}],"standard_charges":[{"minimum":129.1,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1764.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1799.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1782.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1790.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1747.18,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE LYMPH NODE LESION","code_information":[{"code":"38300","type":"CPT"}],"standard_charges":[{"minimum":221.36,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE LYMPH NODE LESION","code_information":[{"code":"38305","type":"CPT"}],"standard_charges":[{"minimum":521.41,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"INCISION OF LYMPH CHANNELS","code_information":[{"code":"38308","type":"CPT"}],"standard_charges":[{"minimum":494.23,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"THORACIC DUCT PROCEDURE","code_information":[{"code":"38380","type":"CPT"}],"standard_charges":[{"minimum":609.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.74,"methodology":"fee schedule"}]}]},{"description":"THORACIC DUCT PROCEDURE","code_information":[{"code":"38381","type":"CPT"}],"standard_charges":[{"minimum":833.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":833.96,"methodology":"fee schedule"}]}]},{"description":"THORACIC DUCT PROCEDURE","code_information":[{"code":"38382","type":"CPT"}],"standard_charges":[{"minimum":710.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.94,"methodology":"fee schedule"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38500","type":"CPT"}],"standard_charges":[{"minimum":267.86,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BIOPSY LYMPH NODES","code_information":[{"code":"38505","type":"CPT"}],"standard_charges":[{"minimum":89.05,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38510","type":"CPT"}],"standard_charges":[{"minimum":439.15,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38520","type":"CPT"}],"standard_charges":[{"minimum":491.72,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38525","type":"CPT"}],"standard_charges":[{"minimum":463.83,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38530","type":"CPT"}],"standard_charges":[{"minimum":595.07,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"OPEN BX/EXC INGUINOFEM NODES","code_information":[{"code":"38531","type":"CPT"}],"standard_charges":[{"minimum":470.27,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"EXPLORE DEEP NODE(S) NECK","code_information":[{"code":"38542","type":"CPT"}],"standard_charges":[{"minimum":552.52,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL NECK/ARMPIT LESION","code_information":[{"code":"38550","type":"CPT"}],"standard_charges":[{"minimum":550.37,"maximum":4203.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4122.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4203.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4162.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4183.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4081.32,"methodology":"fee schedule"}]}]},{"description":"REMOVAL NECK/ARMPIT LESION","code_information":[{"code":"38555","type":"CPT"}],"standard_charges":[{"minimum":1074.28,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"REMOVAL PELVIC LYMPH NODES","code_information":[{"code":"38562","type":"CPT"}],"standard_charges":[{"minimum":743.13,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.13,"methodology":"fee schedule"}]}]},{"description":"REMOVAL ABDOMEN LYMPH NODES","code_information":[{"code":"38564","type":"CPT"}],"standard_charges":[{"minimum":733.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.83,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY LYMPH NODE BIOP","code_information":[{"code":"38570","type":"CPT"}],"standard_charges":[{"minimum":542.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY LYMPHADENECTOMY","code_information":[{"code":"38571","type":"CPT"}],"standard_charges":[{"minimum":693.42,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY LYMPHADENECTOMY","code_information":[{"code":"38572","type":"CPT"}],"standard_charges":[{"minimum":941.96,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPS PELVIC LYMPHADEC","code_information":[{"code":"38573","type":"CPT"}],"standard_charges":[{"minimum":1234.49,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1234.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1234.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1234.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC LYMPHATIC","code_information":[{"code":"38589","type":"CPT"}],"standard_charges":[{"minimum":2897.78,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LYMPH NODES NECK","code_information":[{"code":"38700","type":"CPT"}],"standard_charges":[{"minimum":849.34,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":849.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":849.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":849.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LYMPH NODES NECK","code_information":[{"code":"38720","type":"CPT"}],"standard_charges":[{"minimum":1411.87,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LYMPH NODES NECK","code_information":[{"code":"38724","type":"CPT"}],"standard_charges":[{"minimum":1525.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"}]}]},{"description":"REMOVE ARMPIT LYMPH NODES","code_information":[{"code":"38740","type":"CPT"}],"standard_charges":[{"minimum":737.05,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE ARMPIT LYMPH NODES","code_information":[{"code":"38745","type":"CPT"}],"standard_charges":[{"minimum":925.51,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":925.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":925.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":925.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE THORACIC LYMPH NODES","code_information":[{"code":"38746","type":"CPT"}],"standard_charges":[{"minimum":218.5,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.5,"methodology":"fee schedule"}]}]},{"description":"REMOVE ABDOMINAL LYMPH NODES","code_information":[{"code":"38747","type":"CPT"}],"standard_charges":[{"minimum":275.37,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.37,"methodology":"fee schedule"}]}]},{"description":"REMOVE GROIN LYMPH NODES","code_information":[{"code":"38760","type":"CPT"}],"standard_charges":[{"minimum":877.59,"maximum":7159.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.7,"methodology":"fee schedule"}]}]},{"description":"REMOVE GROIN LYMPH NODES","code_information":[{"code":"38765","type":"CPT"}],"standard_charges":[{"minimum":1368.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.24,"methodology":"fee schedule"}]}]},{"description":"REMOVE PELVIS LYMPH NODES","code_information":[{"code":"38770","type":"CPT"}],"standard_charges":[{"minimum":846.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.48,"methodology":"fee schedule"}]}]},{"description":"REMOVE ABDOMEN LYMPH NODES","code_information":[{"code":"38780","type":"CPT"}],"standard_charges":[{"minimum":1101.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.46,"methodology":"fee schedule"}]}]},{"description":"INJECT FOR LYMPHATIC X-RAY","code_information":[{"code":"38790","type":"CPT"}],"standard_charges":[{"minimum":85.47,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"}]}]},{"description":"RA TRACER ID OF SENTINL NODE","code_information":[{"code":"38792","type":"CPT"}],"standard_charges":[{"minimum":33.26,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":488.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":488.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":432.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":441.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":436.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":438.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"}]}]},{"description":"ACCESS THORACIC LYMPH DUCT","code_information":[{"code":"38794","type":"CPT"}],"standard_charges":[{"minimum":293.6,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.6,"methodology":"fee schedule"}]}]},{"description":"IO MAP OF SENT LYMPH NODE","code_information":[{"code":"38900","type":"CPT"}],"standard_charges":[{"minimum":142.33,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"}]}]},{"description":"BLOOD/LYMPH SYSTEM PROCEDURE","code_information":[{"code":"38999","type":"CPT"}],"standard_charges":[{"minimum":295.07,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":470.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":475.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":477.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.96,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF CHEST","code_information":[{"code":"39000","type":"CPT"}],"standard_charges":[{"minimum":527.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.49,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF CHEST","code_information":[{"code":"39010","type":"CPT"}],"standard_charges":[{"minimum":816.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.44,"methodology":"fee schedule"}]}]},{"description":"RESECT MEDIASTINAL CYST","code_information":[{"code":"39200","type":"CPT"}],"standard_charges":[{"minimum":896.9,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.9,"methodology":"fee schedule"}]}]},{"description":"RESECT MEDIASTINAL TUMOR","code_information":[{"code":"39220","type":"CPT"}],"standard_charges":[{"minimum":1173.7,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"}]}]},{"description":"MEDIASTINOSCPY W/MEDSTNL BX","code_information":[{"code":"39401","type":"CPT"}],"standard_charges":[{"minimum":316.85,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"MEDIASTINOSCPY W/LMPH NOD BX","code_information":[{"code":"39402","type":"CPT"}],"standard_charges":[{"minimum":413.41,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"CHEST PROCEDURE","code_information":[{"code":"39499","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR DIAPHRAGM LACERATION","code_information":[{"code":"39501","type":"CPT"}],"standard_charges":[{"minimum":889.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.04,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF DIAPHRAGM HERNIA","code_information":[{"code":"39503","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5943.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5943.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5943.24,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF DIAPHRAGM HERNIA","code_information":[{"code":"39540","type":"CPT"}],"standard_charges":[{"minimum":902.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.63,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF DIAPHRAGM HERNIA","code_information":[{"code":"39541","type":"CPT"}],"standard_charges":[{"minimum":969.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"}]}]},{"description":"REVISION OF DIAPHRAGM","code_information":[{"code":"39545","type":"CPT"}],"standard_charges":[{"minimum":927.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.3,"methodology":"fee schedule"}]}]},{"description":"RESECT DIAPHRAGM SIMPLE","code_information":[{"code":"39560","type":"CPT"}],"standard_charges":[{"minimum":837.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"}]}]},{"description":"RESECT DIAPHRAGM COMPLEX","code_information":[{"code":"39561","type":"CPT"}],"standard_charges":[{"minimum":1305.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.3,"methodology":"fee schedule"}]}]},{"description":"DIAPHRAGM SURGERY PROCEDURE","code_information":[{"code":"39599","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BIOPSY OF LIP","code_information":[{"code":"40490","type":"CPT"}],"standard_charges":[{"minimum":72.24,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"PARTIAL EXCISION OF LIP","code_information":[{"code":"40500","type":"CPT"}],"standard_charges":[{"minimum":393.02,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PARTIAL EXCISION OF LIP","code_information":[{"code":"40510","type":"CPT"}],"standard_charges":[{"minimum":369.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PARTIAL EXCISION OF LIP","code_information":[{"code":"40520","type":"CPT"}],"standard_charges":[{"minimum":377.64,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":377.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":377.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":377.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT LIP WITH FLAP","code_information":[{"code":"40525","type":"CPT"}],"standard_charges":[{"minimum":583.27,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT LIP WITH FLAP","code_information":[{"code":"40527","type":"CPT"}],"standard_charges":[{"minimum":664.81,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LIP","code_information":[{"code":"40530","type":"CPT"}],"standard_charges":[{"minimum":429.14,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR LIP","code_information":[{"code":"40650","type":"CPT"}],"standard_charges":[{"minimum":335.44,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"REPAIR LIP","code_information":[{"code":"40652","type":"CPT"}],"standard_charges":[{"minimum":382.65,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"REPAIR LIP","code_information":[{"code":"40654","type":"CPT"}],"standard_charges":[{"minimum":451.67,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40700","type":"CPT"}],"standard_charges":[{"minimum":1057.47,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40701","type":"CPT"}],"standard_charges":[{"minimum":1246.65,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40702","type":"CPT"}],"standard_charges":[{"minimum":1048.18,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40720","type":"CPT"}],"standard_charges":[{"minimum":1075.35,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40761","type":"CPT"}],"standard_charges":[{"minimum":1129,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LIP SURGERY PROCEDURE","code_information":[{"code":"40799","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2929.91,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2929.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2197.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2197.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"40800","type":"CPT"}],"standard_charges":[{"minimum":125.52,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"40801","type":"CPT"}],"standard_charges":[{"minimum":209.56,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"REMOVAL FOREIGN BODY MOUTH","code_information":[{"code":"40804","type":"CPT"}],"standard_charges":[{"minimum":120.52,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"REMOVAL FOREIGN BODY MOUTH","code_information":[{"code":"40805","type":"CPT"}],"standard_charges":[{"minimum":208.49,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"INCISION OF LIP FOLD","code_information":[{"code":"40806","type":"CPT"}],"standard_charges":[{"minimum":31.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF MOUTH LESION","code_information":[{"code":"40808","type":"CPT"}],"standard_charges":[{"minimum":94.05,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF MOUTH LESION","code_information":[{"code":"40810","type":"CPT"}],"standard_charges":[{"minimum":129.46,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISE/REPAIR MOUTH LESION","code_information":[{"code":"40812","type":"CPT"}],"standard_charges":[{"minimum":192.04,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXCISE/REPAIR MOUTH LESION","code_information":[{"code":"40814","type":"CPT"}],"standard_charges":[{"minimum":298.61,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF MOUTH LESION","code_information":[{"code":"40816","type":"CPT"}],"standard_charges":[{"minimum":321.14,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISE ORAL MUCOSA FOR GRAFT","code_information":[{"code":"40818","type":"CPT"}],"standard_charges":[{"minimum":279.66,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"EXCISE LIP OR CHEEK FOLD","code_information":[{"code":"40819","type":"CPT"}],"standard_charges":[{"minimum":210.64,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF MOUTH LESION","code_information":[{"code":"40820","type":"CPT"}],"standard_charges":[{"minimum":175.23,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR MOUTH LACERATION","code_information":[{"code":"40830","type":"CPT"}],"standard_charges":[{"minimum":153.06,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR MOUTH LACERATION","code_information":[{"code":"40831","type":"CPT"}],"standard_charges":[{"minimum":211.35,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40840","type":"CPT"}],"standard_charges":[{"minimum":667.31,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40842","type":"CPT"}],"standard_charges":[{"minimum":712.73,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40843","type":"CPT"}],"standard_charges":[{"minimum":913.35,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40844","type":"CPT"}],"standard_charges":[{"minimum":1235.92,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40845","type":"CPT"}],"standard_charges":[{"minimum":1268.83,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1268.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1268.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1268.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"MOUTH SURGERY PROCEDURE","code_information":[{"code":"40899","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41000","type":"CPT"}],"standard_charges":[{"minimum":110.15,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41005","type":"CPT"}],"standard_charges":[{"minimum":122.66,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":863.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":647.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":647.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41006","type":"CPT"}],"standard_charges":[{"minimum":243.89,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41007","type":"CPT"}],"standard_charges":[{"minimum":233.88,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41008","type":"CPT"}],"standard_charges":[{"minimum":272.15,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41009","type":"CPT"}],"standard_charges":[{"minimum":301.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TONGUE FOLD","code_information":[{"code":"41010","type":"CPT"}],"standard_charges":[{"minimum":116.58,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41015","type":"CPT"}],"standard_charges":[{"minimum":315.06,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41016","type":"CPT"}],"standard_charges":[{"minimum":362.98,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41017","type":"CPT"}],"standard_charges":[{"minimum":360.84,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41018","type":"CPT"}],"standard_charges":[{"minimum":420.92,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"PLACE NEEDLES HN FOR RT","code_information":[{"code":"41019","type":"CPT"}],"standard_charges":[{"minimum":512.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF TONGUE","code_information":[{"code":"41100","type":"CPT"}],"standard_charges":[{"minimum":113.36,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF TONGUE","code_information":[{"code":"41105","type":"CPT"}],"standard_charges":[{"minimum":116.58,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF FLOOR OF MOUTH","code_information":[{"code":"41108","type":"CPT"}],"standard_charges":[{"minimum":96.56,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF TONGUE LESION","code_information":[{"code":"41110","type":"CPT"}],"standard_charges":[{"minimum":137.32,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF TONGUE LESION","code_information":[{"code":"41112","type":"CPT"}],"standard_charges":[{"minimum":256.41,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF TONGUE LESION","code_information":[{"code":"41113","type":"CPT"}],"standard_charges":[{"minimum":278.58,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF TONGUE LESION","code_information":[{"code":"41114","type":"CPT"}],"standard_charges":[{"minimum":655.51,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF TONGUE FOLD","code_information":[{"code":"41115","type":"CPT"}],"standard_charges":[{"minimum":154.49,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF MOUTH LESION","code_information":[{"code":"41116","type":"CPT"}],"standard_charges":[{"minimum":228.87,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF TONGUE","code_information":[{"code":"41120","type":"CPT"}],"standard_charges":[{"minimum":1108.26,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1108.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1108.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1108.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF TONGUE","code_information":[{"code":"41130","type":"CPT"}],"standard_charges":[{"minimum":1371.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.1,"methodology":"fee schedule"}]}]},{"description":"TONGUE AND NECK SURGERY","code_information":[{"code":"41135","type":"CPT"}],"standard_charges":[{"minimum":2260.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2260.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2260.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2260.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TONGUE","code_information":[{"code":"41140","type":"CPT"}],"standard_charges":[{"minimum":2276.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2276.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2276.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2276.95,"methodology":"fee schedule"}]}]},{"description":"TONGUE REMOVAL NECK SURGERY","code_information":[{"code":"41145","type":"CPT"}],"standard_charges":[{"minimum":2867.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2867.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2867.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2867.02,"methodology":"fee schedule"}]}]},{"description":"TONGUE MOUTH JAW SURGERY","code_information":[{"code":"41150","type":"CPT"}],"standard_charges":[{"minimum":2293.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2293.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2293.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2293.76,"methodology":"fee schedule"}]}]},{"description":"TONGUE MOUTH NECK SURGERY","code_information":[{"code":"41153","type":"CPT"}],"standard_charges":[{"minimum":2495.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2495.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2495.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2495.81,"methodology":"fee schedule"}]}]},{"description":"TONGUE JAW  NECK SURGERY","code_information":[{"code":"41155","type":"CPT"}],"standard_charges":[{"minimum":3110.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3110.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3110.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3110.91,"methodology":"fee schedule"}]}]},{"description":"REPAIR TONGUE LACERATION","code_information":[{"code":"41250","type":"CPT"}],"standard_charges":[{"minimum":162,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"REPAIR TONGUE LACERATION","code_information":[{"code":"41251","type":"CPT"}],"standard_charges":[{"minimum":193.11,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR TONGUE LACERATION","code_information":[{"code":"41252","type":"CPT"}],"standard_charges":[{"minimum":219.93,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"TONGUE TO LIP SURGERY","code_information":[{"code":"41510","type":"CPT"}],"standard_charges":[{"minimum":477.78,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"TONGUE SUSPENSION","code_information":[{"code":"41512","type":"CPT"}],"standard_charges":[{"minimum":699.86,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION TONGUE FOLD","code_information":[{"code":"41520","type":"CPT"}],"standard_charges":[{"minimum":266.07,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"TONGUE BASE VOL REDUCTION","code_information":[{"code":"41530","type":"CPT"}],"standard_charges":[{"minimum":396.6,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"TONGUE AND MOUTH SURGERY","code_information":[{"code":"41599","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF GUM LESION","code_information":[{"code":"41800","type":"CPT"}],"standard_charges":[{"minimum":137.38,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL FOREIGN BODY GUM","code_information":[{"code":"41805","type":"CPT"}],"standard_charges":[{"minimum":204.91,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVAL FOREIGN BODY JAWBONE","code_information":[{"code":"41806","type":"CPT"}],"standard_charges":[{"minimum":290.39,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXCISION GUM EACH QUADRANT","code_information":[{"code":"41820","type":"CPT"}],"standard_charges":[{"minimum":1530.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF GUM FLAP","code_information":[{"code":"41821","type":"CPT"}],"standard_charges":[{"minimum":1005.29,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41822","type":"CPT"}],"standard_charges":[{"minimum":212.42,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41823","type":"CPT"}],"standard_charges":[{"minimum":388.01,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41825","type":"CPT"}],"standard_charges":[{"minimum":128.38,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41826","type":"CPT"}],"standard_charges":[{"minimum":205.27,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41827","type":"CPT"}],"standard_charges":[{"minimum":304.33,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41828","type":"CPT"}],"standard_charges":[{"minimum":233.17,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF GUM TISSUE","code_information":[{"code":"41830","type":"CPT"}],"standard_charges":[{"minimum":329.72,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF GUM LESION","code_information":[{"code":"41850","type":"CPT"}],"standard_charges":[{"minimum":1005.29,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"GUM GRAFT","code_information":[{"code":"41870","type":"CPT"}],"standard_charges":[{"minimum":1005.29,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REPAIR GUM","code_information":[{"code":"41872","type":"CPT"}],"standard_charges":[{"minimum":321.86,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR TOOTH SOCKET","code_information":[{"code":"41874","type":"CPT"}],"standard_charges":[{"minimum":257.13,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"DENTAL SURGERY PROCEDURE","code_information":[{"code":"41899","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE MOUTH ROOF LESION","code_information":[{"code":"42000","type":"CPT"}],"standard_charges":[{"minimum":115.87,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"BIOPSY ROOF OF MOUTH","code_information":[{"code":"42100","type":"CPT"}],"standard_charges":[{"minimum":116.58,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXCISION LESION MOUTH ROOF","code_information":[{"code":"42104","type":"CPT"}],"standard_charges":[{"minimum":142.69,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION LESION MOUTH ROOF","code_information":[{"code":"42106","type":"CPT"}],"standard_charges":[{"minimum":169.15,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION LESION MOUTH ROOF","code_information":[{"code":"42107","type":"CPT"}],"standard_charges":[{"minimum":341.52,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE PALATE/LESION","code_information":[{"code":"42120","type":"CPT"}],"standard_charges":[{"minimum":1051.75,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF UVULA","code_information":[{"code":"42140","type":"CPT"}],"standard_charges":[{"minimum":173.09,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR PALATE PHARYNX/UVULA","code_information":[{"code":"42145","type":"CPT"}],"standard_charges":[{"minimum":727.39,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TREATMENT MOUTH ROOF LESION","code_information":[{"code":"42160","type":"CPT"}],"standard_charges":[{"minimum":148.77,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR PALATE","code_information":[{"code":"42180","type":"CPT"}],"standard_charges":[{"minimum":198.48,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"REPAIR PALATE","code_information":[{"code":"42182","type":"CPT"}],"standard_charges":[{"minimum":272.86,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42200","type":"CPT"}],"standard_charges":[{"minimum":972,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42205","type":"CPT"}],"standard_charges":[{"minimum":1010.63,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1010.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1010.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1010.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42210","type":"CPT"}],"standard_charges":[{"minimum":1127.92,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42215","type":"CPT"}],"standard_charges":[{"minimum":738.48,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42220","type":"CPT"}],"standard_charges":[{"minimum":608.66,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42225","type":"CPT"}],"standard_charges":[{"minimum":1028.86,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LENGTHENING OF PALATE","code_information":[{"code":"42226","type":"CPT"}],"standard_charges":[{"minimum":953.41,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"LENGTHENING OF PALATE","code_information":[{"code":"42227","type":"CPT"}],"standard_charges":[{"minimum":888.68,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR PALATE","code_information":[{"code":"42235","type":"CPT"}],"standard_charges":[{"minimum":782.11,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR NOSE TO LIP FISTULA","code_information":[{"code":"42260","type":"CPT"}],"standard_charges":[{"minimum":709.15,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PREPARATION PALATE MOLD","code_information":[{"code":"42280","type":"CPT"}],"standard_charges":[{"minimum":114.44,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"INSERTION PALATE PROSTHESIS","code_information":[{"code":"42281","type":"CPT"}],"standard_charges":[{"minimum":169.51,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PALATE/UVULA SURGERY","code_information":[{"code":"42299","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"42300","type":"CPT"}],"standard_charges":[{"minimum":165.93,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"42305","type":"CPT"}],"standard_charges":[{"minimum":459.54,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"42310","type":"CPT"}],"standard_charges":[{"minimum":142.69,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"42320","type":"CPT"}],"standard_charges":[{"minimum":189.89,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SALIVARY STONE","code_information":[{"code":"42330","type":"CPT"}],"standard_charges":[{"minimum":175.23,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SALIVARY STONE","code_information":[{"code":"42335","type":"CPT"}],"standard_charges":[{"minimum":279.66,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SALIVARY STONE","code_information":[{"code":"42340","type":"CPT"}],"standard_charges":[{"minimum":366.2,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF SALIVARY GLAND","code_information":[{"code":"42400","type":"CPT"}],"standard_charges":[{"minimum":55.43,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF SALIVARY GLAND","code_information":[{"code":"42405","type":"CPT"}],"standard_charges":[{"minimum":240.32,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF SALIVARY CYST","code_information":[{"code":"42408","type":"CPT"}],"standard_charges":[{"minimum":367.99,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SALIVARY CYST","code_information":[{"code":"42409","type":"CPT"}],"standard_charges":[{"minimum":247.11,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42410","type":"CPT"}],"standard_charges":[{"minimum":666.24,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42415","type":"CPT"}],"standard_charges":[{"minimum":1116.48,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42420","type":"CPT"}],"standard_charges":[{"minimum":1248.8,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42425","type":"CPT"}],"standard_charges":[{"minimum":885.82,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42426","type":"CPT"}],"standard_charges":[{"minimum":1418.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.67,"methodology":"fee schedule"}]}]},{"description":"EXCISE SUBMAXILLARY GLAND","code_information":[{"code":"42440","type":"CPT"}],"standard_charges":[{"minimum":441.3,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE SUBLINGUAL GLAND","code_information":[{"code":"42450","type":"CPT"}],"standard_charges":[{"minimum":386.58,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR SALIVARY DUCT","code_information":[{"code":"42500","type":"CPT"}],"standard_charges":[{"minimum":366.2,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR SALIVARY DUCT","code_information":[{"code":"42505","type":"CPT"}],"standard_charges":[{"minimum":486.36,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PAROTID DUCT DIVERSION","code_information":[{"code":"42507","type":"CPT"}],"standard_charges":[{"minimum":523.91,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PAROTID DUCT DIVERSION","code_information":[{"code":"42509","type":"CPT"}],"standard_charges":[{"minimum":862.93,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PAROTID DUCT DIVERSION","code_information":[{"code":"42510","type":"CPT"}],"standard_charges":[{"minimum":642.64,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":642.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":642.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":642.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR SALIVARY X-RAY","code_information":[{"code":"42550","type":"CPT"}],"standard_charges":[{"minimum":63.3,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF SALIVARY FISTULA","code_information":[{"code":"42600","type":"CPT"}],"standard_charges":[{"minimum":378.72,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"DILATION OF SALIVARY DUCT","code_information":[{"code":"42650","type":"CPT"}],"standard_charges":[{"minimum":62.23,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"DILATION OF SALIVARY DUCT","code_information":[{"code":"42660","type":"CPT"}],"standard_charges":[{"minimum":90.48,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF SALIVARY DUCT","code_information":[{"code":"42665","type":"CPT"}],"standard_charges":[{"minimum":231.38,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"SALIVARY SURGERY PROCEDURE","code_information":[{"code":"42699","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF TONSIL ABSCESS","code_information":[{"code":"42700","type":"CPT"}],"standard_charges":[{"minimum":144.12,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF THROAT ABSCESS","code_information":[{"code":"42720","type":"CPT"}],"standard_charges":[{"minimum":406.25,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF THROAT ABSCESS","code_information":[{"code":"42725","type":"CPT"}],"standard_charges":[{"minimum":842.55,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF THROAT","code_information":[{"code":"42800","type":"CPT"}],"standard_charges":[{"minimum":124.09,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF UPPER NOSE/THROAT","code_information":[{"code":"42804","type":"CPT"}],"standard_charges":[{"minimum":130.89,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF UPPER NOSE/THROAT","code_information":[{"code":"42806","type":"CPT"}],"standard_charges":[{"minimum":150.2,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISE PHARYNX LESION","code_information":[{"code":"42808","type":"CPT"}],"standard_charges":[{"minimum":175.95,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVE PHARYNX FOREIGN BODY","code_information":[{"code":"42809","type":"CPT"}],"standard_charges":[{"minimum":134.11,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF NECK CYST","code_information":[{"code":"42810","type":"CPT"}],"standard_charges":[{"minimum":300.76,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF NECK CYST","code_information":[{"code":"42815","type":"CPT"}],"standard_charges":[{"minimum":569.68,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":569.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":569.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":569.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE TONSILS AND ADENOIDS","code_information":[{"code":"42820","type":"CPT"}],"standard_charges":[{"minimum":309.7,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE TONSILS AND ADENOIDS","code_information":[{"code":"42821","type":"CPT"}],"standard_charges":[{"minimum":323.29,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TONSILS","code_information":[{"code":"42825","type":"CPT"}],"standard_charges":[{"minimum":285.74,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TONSILS","code_information":[{"code":"42826","type":"CPT"}],"standard_charges":[{"minimum":272.15,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ADENOIDS","code_information":[{"code":"42830","type":"CPT"}],"standard_charges":[{"minimum":227.09,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ADENOIDS","code_information":[{"code":"42831","type":"CPT"}],"standard_charges":[{"minimum":246.76,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ADENOIDS","code_information":[{"code":"42835","type":"CPT"}],"standard_charges":[{"minimum":212.07,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ADENOIDS","code_information":[{"code":"42836","type":"CPT"}],"standard_charges":[{"minimum":261.42,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE SURGERY OF THROAT","code_information":[{"code":"42842","type":"CPT"}],"standard_charges":[{"minimum":1061.41,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE SURGERY OF THROAT","code_information":[{"code":"42844","type":"CPT"}],"standard_charges":[{"minimum":1443.7,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE SURGERY OF THROAT","code_information":[{"code":"42845","type":"CPT"}],"standard_charges":[{"minimum":2304.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.13,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF TONSIL TAGS","code_information":[{"code":"42860","type":"CPT"}],"standard_charges":[{"minimum":207.42,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF LINGUAL TONSIL","code_information":[{"code":"42870","type":"CPT"}],"standard_charges":[{"minimum":619.75,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF PHARYNX","code_information":[{"code":"42890","type":"CPT"}],"standard_charges":[{"minimum":1484.47,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PHARYNGEAL WALLS","code_information":[{"code":"42892","type":"CPT"}],"standard_charges":[{"minimum":1950.44,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1950.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1950.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1950.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PHARYNGEAL WALLS","code_information":[{"code":"42894","type":"CPT"}],"standard_charges":[{"minimum":2472.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2472.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2472.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2472.92,"methodology":"fee schedule"}]}]},{"description":"REPAIR THROAT WOUND","code_information":[{"code":"42900","type":"CPT"}],"standard_charges":[{"minimum":350.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF THROAT","code_information":[{"code":"42950","type":"CPT"}],"standard_charges":[{"minimum":837.54,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR THROAT ESOPHAGUS","code_information":[{"code":"42953","type":"CPT"}],"standard_charges":[{"minimum":1003.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1003.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1003.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1003.47,"methodology":"fee schedule"}]}]},{"description":"SURGICAL OPENING OF THROAT","code_information":[{"code":"42955","type":"CPT"}],"standard_charges":[{"minimum":797.84,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"CONTROL THROAT BLEEDING","code_information":[{"code":"42960","type":"CPT"}],"standard_charges":[{"minimum":170.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"CONTROL THROAT BLEEDING","code_information":[{"code":"42961","type":"CPT"}],"standard_charges":[{"minimum":444.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.88,"methodology":"fee schedule"}]}]},{"description":"CONTROL THROAT BLEEDING","code_information":[{"code":"42962","type":"CPT"}],"standard_charges":[{"minimum":547.87,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"CONTROL NOSE/THROAT BLEEDING","code_information":[{"code":"42970","type":"CPT"}],"standard_charges":[{"minimum":217.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":217.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":436.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":436.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":436.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"CONTROL NOSE/THROAT BLEEDING","code_information":[{"code":"42971","type":"CPT"}],"standard_charges":[{"minimum":480.28,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"}]}]},{"description":"CONTROL NOSE/THROAT BLEEDING","code_information":[{"code":"42972","type":"CPT"}],"standard_charges":[{"minimum":536.78,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"THROAT SURGERY PROCEDURE","code_information":[{"code":"42999","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"INCISION OF ESOPHAGUS","code_information":[{"code":"43020","type":"CPT"}],"standard_charges":[{"minimum":594.72,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":594.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":594.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":594.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"THROAT MUSCLE SURGERY","code_information":[{"code":"43030","type":"CPT"}],"standard_charges":[{"minimum":554.31,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":554.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":554.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":554.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"INCISION OF ESOPHAGUS","code_information":[{"code":"43045","type":"CPT"}],"standard_charges":[{"minimum":1348.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.93,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF ESOPHAGUS LESION","code_information":[{"code":"43100","type":"CPT"}],"standard_charges":[{"minimum":673.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF ESOPHAGUS LESION","code_information":[{"code":"43101","type":"CPT"}],"standard_charges":[{"minimum":1040.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.31,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ESOPHAGUS","code_information":[{"code":"43107","type":"CPT"}],"standard_charges":[{"minimum":3065.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3065.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3065.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3065.14,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ESOPHAGUS","code_information":[{"code":"43108","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4544.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4544.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4544.24,"methodology":"fee schedule"}]}]},{"description":"ESPHG TOT W/THRCM","code_information":[{"code":"43112","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3552.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3552.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3552.57,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ESOPHAGUS","code_information":[{"code":"43113","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4447.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4447.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4447.68,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43116","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5079.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5079.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5079.59,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43117","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3348.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3348.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3348.73,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43118","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3709.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3709.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3709.2,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43121","type":"CPT"}],"standard_charges":[{"minimum":2933.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2933.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2933.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2933.17,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43122","type":"CPT"}],"standard_charges":[{"minimum":2657.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2657.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2657.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2657.09,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43123","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4608.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4608.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4608.97,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ESOPHAGUS","code_information":[{"code":"43124","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3903.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3903.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3903.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ESOPHAGUS POUCH","code_information":[{"code":"43130","type":"CPT"}],"standard_charges":[{"minimum":835.04,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ESOPHAGUS POUCH","code_information":[{"code":"43135","type":"CPT"}],"standard_charges":[{"minimum":1512,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY RIGID TRNSO","code_information":[{"code":"43180","type":"CPT"}],"standard_charges":[{"minimum":575.76,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY RIGID TRNSO DX","code_information":[{"code":"43191","type":"CPT"}],"standard_charges":[{"minimum":163.07,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCP RIG TRNSO INJECT","code_information":[{"code":"43192","type":"CPT"}],"standard_charges":[{"minimum":178.09,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCP RIG TRNSO BIOPSY","code_information":[{"code":"43193","type":"CPT"}],"standard_charges":[{"minimum":177.38,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCP RIG TRNSO REM FB","code_information":[{"code":"43194","type":"CPT"}],"standard_charges":[{"minimum":198.84,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY RIGID BALLOON","code_information":[{"code":"43195","type":"CPT"}],"standard_charges":[{"minimum":193.83,"maximum":4176.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCP GUIDE WIRE DILAT","code_information":[{"code":"43196","type":"CPT"}],"standard_charges":[{"minimum":205.27,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY FLEX DX BRUSH","code_information":[{"code":"43197","type":"CPT"}],"standard_charges":[{"minimum":85.47,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSC FLEX TRNSN BIOPSY","code_information":[{"code":"43198","type":"CPT"}],"standard_charges":[{"minimum":101.92,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY FLEXIBLE BRUSH","code_information":[{"code":"43200","type":"CPT"}],"standard_charges":[{"minimum":91.55,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"ESOPH SCOPE W/SUBMUCOUS INJ","code_information":[{"code":"43201","type":"CPT"}],"standard_charges":[{"minimum":108,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY FLEX BIOPSY","code_information":[{"code":"43202","type":"CPT"}],"standard_charges":[{"minimum":107.29,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPH SCOPE W/SCLEROSIS INJ","code_information":[{"code":"43204","type":"CPT"}],"standard_charges":[{"minimum":140.19,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGUS ENDOSCOPY/LIGATION","code_information":[{"code":"43205","type":"CPT"}],"standard_charges":[{"minimum":146.27,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPH OPTICAL ENDOMICROSCOPY","code_information":[{"code":"43206","type":"CPT"}],"standard_charges":[{"minimum":137.68,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD ESOPHAGOGASTRC FNDOPLSTY","code_information":[{"code":"43210","type":"CPT"}],"standard_charges":[{"minimum":2049.5,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOP MUCOSAL RESECT","code_information":[{"code":"43211","type":"CPT"}],"standard_charges":[{"minimum":242.82,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOP STENT PLACEMENT","code_information":[{"code":"43212","type":"CPT"}],"standard_charges":[{"minimum":195.26,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY RETRO BALLOON","code_information":[{"code":"43213","type":"CPT"}],"standard_charges":[{"minimum":268.57,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSC DILATE BALLOON 30","code_information":[{"code":"43214","type":"CPT"}],"standard_charges":[{"minimum":201.34,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY FLEX REMOVE FB","code_information":[{"code":"43215","type":"CPT"}],"standard_charges":[{"minimum":146.62,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY LESION REMOVAL","code_information":[{"code":"43216","type":"CPT"}],"standard_charges":[{"minimum":138.76,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY SNARE LES REMV","code_information":[{"code":"43217","type":"CPT"}],"standard_charges":[{"minimum":165.93,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY BALLOON <30MM","code_information":[{"code":"43220","type":"CPT"}],"standard_charges":[{"minimum":122.66,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPH ENDOSCOPY DILATION","code_information":[{"code":"43226","type":"CPT"}],"standard_charges":[{"minimum":135.54,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY CONTROL BLEED","code_information":[{"code":"43227","type":"CPT"}],"standard_charges":[{"minimum":171.3,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY LESION ABLATE","code_information":[{"code":"43229","type":"CPT"}],"standard_charges":[{"minimum":203.84,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOP ULTRASOUND EXAM","code_information":[{"code":"43231","type":"CPT"}],"standard_charges":[{"minimum":163.07,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOSCOPY W/US NEEDLE BX","code_information":[{"code":"43232","type":"CPT"}],"standard_charges":[{"minimum":205.99,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD BALLOON DIL ESOPH30 MM/>","code_information":[{"code":"43233","type":"CPT"}],"standard_charges":[{"minimum":237.1,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD DIAGNOSTIC BRUSH WASH","code_information":[{"code":"43235","type":"CPT"}],"standard_charges":[{"minimum":127.31,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"UPPR GI SCOPE W/SUBMUC INJ","code_information":[{"code":"43236","type":"CPT"}],"standard_charges":[{"minimum":143.76,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPIC US EXAM ESOPH","code_information":[{"code":"43237","type":"CPT"}],"standard_charges":[{"minimum":202.41,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD US FINE NEEDLE BX/ASPIR","code_information":[{"code":"43238","type":"CPT"}],"standard_charges":[{"minimum":239.96,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"43239","type":"CPT"}],"standard_charges":[{"minimum":143.76,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"EGD W/TRANSMURAL DRAIN CYST","code_information":[{"code":"43240","type":"CPT"}],"standard_charges":[{"minimum":405.18,"maximum":6534.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"EGD TUBE/CATH INSERTION","code_information":[{"code":"43241","type":"CPT"}],"standard_charges":[{"minimum":147.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD US FINE NEEDLE BX/ASPIR","code_information":[{"code":"43242","type":"CPT"}],"standard_charges":[{"minimum":271.79,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD INJECTION VARICES","code_information":[{"code":"43243","type":"CPT"}],"standard_charges":[{"minimum":245.68,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD VARICES LIGATION","code_information":[{"code":"43244","type":"CPT"}],"standard_charges":[{"minimum":253.55,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD DILATE STRICTURE","code_information":[{"code":"43245","type":"CPT"}],"standard_charges":[{"minimum":181.67,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD PLACE GASTROSTOMY TUBE","code_information":[{"code":"43246","type":"CPT"}],"standard_charges":[{"minimum":207.06,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD REMOVE FOREIGN BODY","code_information":[{"code":"43247","type":"CPT"}],"standard_charges":[{"minimum":183.1,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"EGD GUIDE WIRE INSERTION","code_information":[{"code":"43248","type":"CPT"}],"standard_charges":[{"minimum":172.37,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"ESOPH EGD DILATION <30 MM","code_information":[{"code":"43249","type":"CPT"}],"standard_charges":[{"minimum":159.14,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD CAUTERY TUMOR POLYP","code_information":[{"code":"43250","type":"CPT"}],"standard_charges":[{"minimum":176.31,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD REMOVE LESION SNARE","code_information":[{"code":"43251","type":"CPT"}],"standard_charges":[{"minimum":202.77,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD OPTICAL ENDOMICROSCOPY","code_information":[{"code":"43252","type":"CPT"}],"standard_charges":[{"minimum":174.52,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD US TRANSMURAL INJXN/MARK","code_information":[{"code":"43253","type":"CPT"}],"standard_charges":[{"minimum":271.43,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD ENDO MUCOSAL RESECTION","code_information":[{"code":"43254","type":"CPT"}],"standard_charges":[{"minimum":278.94,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD CONTROL BLEEDING ANY","code_information":[{"code":"43255","type":"CPT"}],"standard_charges":[{"minimum":207.06,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"EGD W/THRML TXMNT GERD","code_information":[{"code":"43257","type":"CPT"}],"standard_charges":[{"minimum":242.11,"maximum":4176.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"EGD US EXAM DUODENUM/JEJUNUM","code_information":[{"code":"43259","type":"CPT"}],"standard_charges":[{"minimum":233.52,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ERCP W/SPECIMEN COLLECTION","code_information":[{"code":"43260","type":"CPT"}],"standard_charges":[{"minimum":333.3,"maximum":4176.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"ENDO CHOLANGIOPANCREATOGRAPH","code_information":[{"code":"43261","type":"CPT"}],"standard_charges":[{"minimum":349.75,"maximum":4176.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"ENDO CHOLANGIOPANCREATOGRAPH","code_information":[{"code":"43262","type":"CPT"}],"standard_charges":[{"minimum":368.7,"maximum":4176.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"ERCP SPHINCTER PRESSURE MEAS","code_information":[{"code":"43263","type":"CPT"}],"standard_charges":[{"minimum":369.42,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ERCP REMOVE DUCT CALCULI","code_information":[{"code":"43264","type":"CPT"}],"standard_charges":[{"minimum":375.86,"maximum":4176.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"ERCP LITHOTRIPSY CALCULI","code_information":[{"code":"43265","type":"CPT"}],"standard_charges":[{"minimum":447.38,"maximum":6534.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"EGD ENDOSCOPIC STENT PLACE","code_information":[{"code":"43266","type":"CPT"}],"standard_charges":[{"minimum":224.94,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"EGD LESION ABLATION","code_information":[{"code":"43270","type":"CPT"}],"standard_charges":[{"minimum":232.09,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPIC PANCREATOSCOPY","code_information":[{"code":"43273","type":"CPT"}],"standard_charges":[{"minimum":123.02,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.02,"methodology":"fee schedule"}]}]},{"description":"ERCP DUCT STENT PLACEMENT","code_information":[{"code":"43274","type":"CPT"}],"standard_charges":[{"minimum":477.78,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"ERCP REMOVE FORGN BODY DUCT","code_information":[{"code":"43275","type":"CPT"}],"standard_charges":[{"minimum":388.73,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ERCP STENT EXCHANGE W/DILATE","code_information":[{"code":"43276","type":"CPT"}],"standard_charges":[{"minimum":497.45,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"ERCP EA DUCT/AMPULLA DILATE","code_information":[{"code":"43277","type":"CPT"}],"standard_charges":[{"minimum":390.88,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"ERCP LESION ABLATE W/DILATE","code_information":[{"code":"43278","type":"CPT"}],"standard_charges":[{"minimum":447.02,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"LAP MYOTOMY HELLER","code_information":[{"code":"43279","type":"CPT"}],"standard_charges":[{"minimum":1334.27,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.27,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY FUNDOPLASTY","code_information":[{"code":"43280","type":"CPT"}],"standard_charges":[{"minimum":1123.27,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAP PARAESOPHAG HERN REPAIR","code_information":[{"code":"43281","type":"CPT"}],"standard_charges":[{"minimum":1596.4,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAP PARAESOPH HER RPR W/MESH","code_information":[{"code":"43282","type":"CPT"}],"standard_charges":[{"minimum":1798.1,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1798.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1798.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1798.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAP ESOPH LENGTHENING","code_information":[{"code":"43283","type":"CPT"}],"standard_charges":[{"minimum":162.36,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.36,"methodology":"fee schedule"}]}]},{"description":"LAPS ESOPHGL SPHNCTR AGMNTJ","code_information":[{"code":"43284","type":"CPT"}],"standard_charges":[{"minimum":684.12,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"RMVL ESOPHGL SPHNCTR DEV","code_information":[{"code":"43285","type":"CPT"}],"standard_charges":[{"minimum":703.08,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"ESPHG TOT W/LAPS MOBLJ","code_information":[{"code":"43286","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3268.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3268.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3268.98,"methodology":"fee schedule"}]}]},{"description":"ESPHG DSTL 2/3 W/LAPS MOBLJ","code_information":[{"code":"43287","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3653.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3653.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3653.06,"methodology":"fee schedule"}]}]},{"description":"ESPHG THRSC MOBLJ","code_information":[{"code":"43288","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3853.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3853.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3853.32,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC ESOPH","code_information":[{"code":"43289","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ESOPHAGUS","code_information":[{"code":"43300","type":"CPT"}],"standard_charges":[{"minimum":663.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.02,"methodology":"fee schedule"}]}]},{"description":"REPAIR ESOPHAGUS AND FISTULA","code_information":[{"code":"43305","type":"CPT"}],"standard_charges":[{"minimum":1153.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1153.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1153.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1153.31,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ESOPHAGUS","code_information":[{"code":"43310","type":"CPT"}],"standard_charges":[{"minimum":1525.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR ESOPHAGUS AND FISTULA","code_information":[{"code":"43312","type":"CPT"}],"standard_charges":[{"minimum":1628.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1628.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1628.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1628.59,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOPLASTY CONGENITAL","code_information":[{"code":"43313","type":"CPT"}],"standard_charges":[{"minimum":3019.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3019.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3019.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3019.72,"methodology":"fee schedule"}]}]},{"description":"TRACHEO-ESOPHAGOPLASTY CONG","code_information":[{"code":"43314","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3230.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3230.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3230.35,"methodology":"fee schedule"}]}]},{"description":"FUSE ESOPHAGUS  STOMACH","code_information":[{"code":"43320","type":"CPT"}],"standard_charges":[{"minimum":1456.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"}]}]},{"description":"REVISE ESOPHAGUS  STOMACH","code_information":[{"code":"43325","type":"CPT"}],"standard_charges":[{"minimum":1416.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.16,"methodology":"fee schedule"}]}]},{"description":"ESOPH FUNDOPLASTY LAP","code_information":[{"code":"43327","type":"CPT"}],"standard_charges":[{"minimum":851.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.84,"methodology":"fee schedule"}]}]},{"description":"ESOPH FUNDOPLASTY THOR","code_information":[{"code":"43328","type":"CPT"}],"standard_charges":[{"minimum":1155.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1155.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1155.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1155.1,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOMYOTOMY ABDOMINAL","code_information":[{"code":"43330","type":"CPT"}],"standard_charges":[{"minimum":1393.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1393.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1393.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1393.63,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGOMYOTOMY THORACIC","code_information":[{"code":"43331","type":"CPT"}],"standard_charges":[{"minimum":1382.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.55,"methodology":"fee schedule"}]}]},{"description":"TRANSAB ESOPH HIAT HERN RPR","code_information":[{"code":"43332","type":"CPT"}],"standard_charges":[{"minimum":1194.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1194.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1194.8,"methodology":"fee schedule"}]}]},{"description":"TRANSAB ESOPH HIAT HERN RPR","code_information":[{"code":"43333","type":"CPT"}],"standard_charges":[{"minimum":1308.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1308.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1308.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1308.88,"methodology":"fee schedule"}]}]},{"description":"TRANSTHOR DIAPHRAG HERN RPR","code_information":[{"code":"43334","type":"CPT"}],"standard_charges":[{"minimum":1276.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1276.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1276.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1276.69,"methodology":"fee schedule"}]}]},{"description":"TRANSTHOR DIAPHRAG HERN RPR","code_information":[{"code":"43335","type":"CPT"}],"standard_charges":[{"minimum":1370.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.75,"methodology":"fee schedule"}]}]},{"description":"THORABD DIAPHR HERN REPAIR","code_information":[{"code":"43336","type":"CPT"}],"standard_charges":[{"minimum":1489.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.12,"methodology":"fee schedule"}]}]},{"description":"THORABD DIAPHR HERN REPAIR","code_information":[{"code":"43337","type":"CPT"}],"standard_charges":[{"minimum":1586.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.39,"methodology":"fee schedule"}]}]},{"description":"ESOPH LENGTHENING","code_information":[{"code":"43338","type":"CPT"}],"standard_charges":[{"minimum":116.94,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.94,"methodology":"fee schedule"}]}]},{"description":"FUSE ESOPHAGUS  INTESTINE","code_information":[{"code":"43340","type":"CPT"}],"standard_charges":[{"minimum":1439.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1439.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1439.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1439.05,"methodology":"fee schedule"}]}]},{"description":"FUSE ESOPHAGUS  INTESTINE","code_information":[{"code":"43341","type":"CPT"}],"standard_charges":[{"minimum":1445.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1445.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1445.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1445.49,"methodology":"fee schedule"}]}]},{"description":"SURGICAL OPENING ESOPHAGUS","code_information":[{"code":"43351","type":"CPT"}],"standard_charges":[{"minimum":1365.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1365.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1365.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1365.38,"methodology":"fee schedule"}]}]},{"description":"SURGICAL OPENING ESOPHAGUS","code_information":[{"code":"43352","type":"CPT"}],"standard_charges":[{"minimum":1105.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.04,"methodology":"fee schedule"}]}]},{"description":"GASTROINTESTINAL REPAIR","code_information":[{"code":"43360","type":"CPT"}],"standard_charges":[{"minimum":2313.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2313.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2313.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2313.78,"methodology":"fee schedule"}]}]},{"description":"GASTROINTESTINAL REPAIR","code_information":[{"code":"43361","type":"CPT"}],"standard_charges":[{"minimum":2805.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2805.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2805.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2805.51,"methodology":"fee schedule"}]}]},{"description":"LIGATE ESOPHAGUS VEINS","code_information":[{"code":"43400","type":"CPT"}],"standard_charges":[{"minimum":1586.39,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1586.39,"methodology":"fee schedule"}]}]},{"description":"LIGATE/STAPLE ESOPHAGUS","code_information":[{"code":"43405","type":"CPT"}],"standard_charges":[{"minimum":1506.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1506.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1506.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1506.64,"methodology":"fee schedule"}]}]},{"description":"REPAIR ESOPHAGUS WOUND","code_information":[{"code":"43410","type":"CPT"}],"standard_charges":[{"minimum":1090.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR ESOPHAGUS WOUND","code_information":[{"code":"43415","type":"CPT"}],"standard_charges":[{"minimum":2661.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2661.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2661.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2661.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR ESOPHAGUS OPENING","code_information":[{"code":"43420","type":"CPT"}],"standard_charges":[{"minimum":1072.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR ESOPHAGUS OPENING","code_information":[{"code":"43425","type":"CPT"}],"standard_charges":[{"minimum":1487.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1487.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1487.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1487.69,"methodology":"fee schedule"}]}]},{"description":"DILATE ESOPHAGUS 1/MULT PASS","code_information":[{"code":"43450","type":"CPT"}],"standard_charges":[{"minimum":82.97,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"DILATE ESOPHAGUS","code_information":[{"code":"43453","type":"CPT"}],"standard_charges":[{"minimum":90.48,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"PRESSURE TREATMENT ESOPHAGUS","code_information":[{"code":"43460","type":"CPT"}],"standard_charges":[{"minimum":219.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.93,"methodology":"fee schedule"}]}]},{"description":"FREE JEJUNUM FLAP MICROVASC","code_information":[{"code":"43496","type":"CPT"}],"standard_charges":[{"minimum":949.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.24,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGUS SURGERY PROCEDURE","code_information":[{"code":"43499","type":"CPT"}],"standard_charges":[{"minimum":601.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"SURGICAL OPENING OF STOMACH","code_information":[{"code":"43500","type":"CPT"}],"standard_charges":[{"minimum":823.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.23,"methodology":"fee schedule"}]}]},{"description":"SURGICAL REPAIR OF STOMACH","code_information":[{"code":"43501","type":"CPT"}],"standard_charges":[{"minimum":1410.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410.44,"methodology":"fee schedule"}]}]},{"description":"SURGICAL REPAIR OF STOMACH","code_information":[{"code":"43502","type":"CPT"}],"standard_charges":[{"minimum":1590.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1590.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1590.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1590.32,"methodology":"fee schedule"}]}]},{"description":"SURGICAL OPENING OF STOMACH","code_information":[{"code":"43510","type":"CPT"}],"standard_charges":[{"minimum":994.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":994.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":994.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":994.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"INCISION OF PYLORIC MUSCLE","code_information":[{"code":"43520","type":"CPT"}],"standard_charges":[{"minimum":724.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF STOMACH","code_information":[{"code":"43605","type":"CPT"}],"standard_charges":[{"minimum":874.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.37,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF STOMACH LESION","code_information":[{"code":"43610","type":"CPT"}],"standard_charges":[{"minimum":1021,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF STOMACH LESION","code_information":[{"code":"43611","type":"CPT"}],"standard_charges":[{"minimum":1282.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.77,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF STOMACH","code_information":[{"code":"43620","type":"CPT"}],"standard_charges":[{"minimum":2061.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2061.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2061.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2061.3,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF STOMACH","code_information":[{"code":"43621","type":"CPT"}],"standard_charges":[{"minimum":2362.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2362.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2362.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2362.78,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF STOMACH","code_information":[{"code":"43622","type":"CPT"}],"standard_charges":[{"minimum":2399.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2399.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2399.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2399.61,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43631","type":"CPT"}],"standard_charges":[{"minimum":1511.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1511.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1511.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1511.29,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43632","type":"CPT"}],"standard_charges":[{"minimum":2116.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2116.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2116.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2116.74,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43633","type":"CPT"}],"standard_charges":[{"minimum":2002.66,"maximum":8615.76,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8615.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2002.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2002.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2002.66,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43634","type":"CPT"}],"standard_charges":[{"minimum":2208.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2208.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2208.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2208.28,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43635","type":"CPT"}],"standard_charges":[{"minimum":116.23,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"}]}]},{"description":"VAGOTOMY  PYLORUS REPAIR","code_information":[{"code":"43640","type":"CPT"}],"standard_charges":[{"minimum":1244.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1244.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1244.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1244.15,"methodology":"fee schedule"}]}]},{"description":"VAGOTOMY  PYLORUS REPAIR","code_information":[{"code":"43641","type":"CPT"}],"standard_charges":[{"minimum":1258.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.45,"methodology":"fee schedule"}]}]},{"description":"LAP GASTRIC BYPASS/ROUX-EN-Y","code_information":[{"code":"43644","type":"CPT"}],"standard_charges":[{"minimum":1809.9,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1809.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1809.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1809.9,"methodology":"fee schedule"}]}]},{"description":"LAP GASTR BYPASS INCL SMLL I","code_information":[{"code":"43645","type":"CPT"}],"standard_charges":[{"minimum":1923.62,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8615.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1923.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1923.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1923.62,"methodology":"fee schedule"}]}]},{"description":"LAP IMPL ELECTRODE ANTRUM","code_information":[{"code":"43647","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":13689.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13424.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13689.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13556.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13623.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"}]}]},{"description":"LAP REVISE/REMV ELTRD ANTRUM","code_information":[{"code":"43648","type":"CPT"}],"standard_charges":[{"minimum":812.81,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY VAGUS NERVE","code_information":[{"code":"43651","type":"CPT"}],"standard_charges":[{"minimum":690.2,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY VAGUS NERVE","code_information":[{"code":"43652","type":"CPT"}],"standard_charges":[{"minimum":803.21,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY GASTROSTOMY","code_information":[{"code":"43653","type":"CPT"}],"standard_charges":[{"minimum":607.95,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC STOM","code_information":[{"code":"43659","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"NASAL/OROGASTRIC W/TUBE PLMT","code_information":[{"code":"43752","type":"CPT"}],"standard_charges":[{"minimum":41.48,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"TX GASTRO INTUB W/ASP","code_information":[{"code":"43753","type":"CPT"}],"standard_charges":[{"minimum":22.53,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":341.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":338.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"}]}]},{"description":"DX GASTR INTUB W/ASP SPEC","code_information":[{"code":"43754","type":"CPT"}],"standard_charges":[{"minimum":39.7,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":341.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":338.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"}]}]},{"description":"DX GASTR INTUB W/ASP SPECS","code_information":[{"code":"43755","type":"CPT"}],"standard_charges":[{"minimum":62.58,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"DX DUOD INTUB W/ASP SPEC","code_information":[{"code":"43756","type":"CPT"}],"standard_charges":[{"minimum":53.28,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"DX DUOD INTUB W/ASP SPECS","code_information":[{"code":"43757","type":"CPT"}],"standard_charges":[{"minimum":80.46,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"REPOSITION GASTROSTOMY TUBE","code_information":[{"code":"43761","type":"CPT"}],"standard_charges":[{"minimum":108,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"RPLC GTUBE NO REVJ TRC","code_information":[{"code":"43762","type":"CPT"}],"standard_charges":[{"minimum":38.62,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"RPLC GTUBE REVJ GSTRST TRC","code_information":[{"code":"43763","type":"CPT"}],"standard_charges":[{"minimum":91.19,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"LAP PLACE GASTR ADJ DEVICE","code_information":[{"code":"43770","type":"CPT"}],"standard_charges":[{"minimum":1177.28,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8615.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAP REVISE GASTR ADJ DEVICE","code_information":[{"code":"43771","type":"CPT"}],"standard_charges":[{"minimum":1334.98,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6401.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4801.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4801.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.98,"methodology":"fee schedule"}]}]},{"description":"LAP RMVL GASTR ADJ DEVICE","code_information":[{"code":"43772","type":"CPT"}],"standard_charges":[{"minimum":992.74,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6401.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4801.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4801.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"LAP REPLACE GASTR ADJ DEVICE","code_information":[{"code":"43773","type":"CPT"}],"standard_charges":[{"minimum":1334.98,"maximum":8615.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8615.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1334.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAP RMVL GASTR ADJ ALL PARTS","code_information":[{"code":"43774","type":"CPT"}],"standard_charges":[{"minimum":1004.55,"maximum":6401.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6401.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4801.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4801.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"LAP SLEEVE GASTRECTOMY","code_information":[{"code":"43775","type":"CPT"}],"standard_charges":[{"minimum":1147.24,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9255.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6943.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6943.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.24,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF PYLORUS","code_information":[{"code":"43800","type":"CPT"}],"standard_charges":[{"minimum":971.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.65,"methodology":"fee schedule"}]}]},{"description":"FUSION OF STOMACH AND BOWEL","code_information":[{"code":"43810","type":"CPT"}],"standard_charges":[{"minimum":1061.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.76,"methodology":"fee schedule"}]}]},{"description":"FUSION OF STOMACH AND BOWEL","code_information":[{"code":"43820","type":"CPT"}],"standard_charges":[{"minimum":1404,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"}]}]},{"description":"FUSION OF STOMACH AND BOWEL","code_information":[{"code":"43825","type":"CPT"}],"standard_charges":[{"minimum":1368.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.6,"methodology":"fee schedule"}]}]},{"description":"PLACE GASTROSTOMY TUBE","code_information":[{"code":"43830","type":"CPT"}],"standard_charges":[{"minimum":737.05,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"PLACE GASTROSTOMY TUBE","code_information":[{"code":"43831","type":"CPT"}],"standard_charges":[{"minimum":641.56,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"PLACE GASTROSTOMY TUBE","code_information":[{"code":"43832","type":"CPT"}],"standard_charges":[{"minimum":1093.59,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF STOMACH LESION","code_information":[{"code":"43840","type":"CPT"}],"standard_charges":[{"minimum":1418.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.31,"methodology":"fee schedule"}]}]},{"description":"V-BAND GASTROPLASTY","code_information":[{"code":"43842","type":"CPT"}],"standard_charges":[{"minimum":1212.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212.32,"methodology":"fee schedule"}]}]},{"description":"GASTROPLASTY W/O V-BAND","code_information":[{"code":"43843","type":"CPT"}],"standard_charges":[{"minimum":1340.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1340.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1340.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1340.71,"methodology":"fee schedule"}]}]},{"description":"GASTROPLASTY DUODENAL SWITCH","code_information":[{"code":"43845","type":"CPT"}],"standard_charges":[{"minimum":2041.28,"maximum":8615.76,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8615.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2041.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2041.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2041.28,"methodology":"fee schedule"}]}]},{"description":"GASTRIC BYPASS FOR OBESITY","code_information":[{"code":"43846","type":"CPT"}],"standard_charges":[{"minimum":1723,"maximum":8615.76,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8615.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1723,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1723,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1723,"methodology":"fee schedule"}]}]},{"description":"GASTRIC BYPASS INCL SMALL I","code_information":[{"code":"43847","type":"CPT"}],"standard_charges":[{"minimum":1884.64,"maximum":8615.76,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8615.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6462.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1884.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1884.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1884.64,"methodology":"fee schedule"}]}]},{"description":"REVISION GASTROPLASTY","code_information":[{"code":"43848","type":"CPT"}],"standard_charges":[{"minimum":2018.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2018.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2018.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2018.03,"methodology":"fee schedule"}]}]},{"description":"REVISE STOMACH-BOWEL FUSION","code_information":[{"code":"43860","type":"CPT"}],"standard_charges":[{"minimum":1704.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1704.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1704.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1704.05,"methodology":"fee schedule"}]}]},{"description":"REVISE STOMACH-BOWEL FUSION","code_information":[{"code":"43865","type":"CPT"}],"standard_charges":[{"minimum":1780.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR STOMACH OPENING","code_information":[{"code":"43870","type":"CPT"}],"standard_charges":[{"minimum":742.41,"maximum":4176.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4095.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4176.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4136.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4156.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4054.94,"methodology":"fee schedule"}]}]},{"description":"REPAIR STOMACH-BOWEL FISTULA","code_information":[{"code":"43880","type":"CPT"}],"standard_charges":[{"minimum":1673.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1673.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1673.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1673.65,"methodology":"fee schedule"}]}]},{"description":"REVISE/REMOVE ELECTRD ANTRUM","code_information":[{"code":"43882","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE GASTRIC PORT OPEN","code_information":[{"code":"43886","type":"CPT"}],"standard_charges":[{"minimum":389.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REMOVE GASTRIC PORT OPEN","code_information":[{"code":"43887","type":"CPT"}],"standard_charges":[{"minimum":351.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"CHANGE GASTRIC PORT OPEN","code_information":[{"code":"43888","type":"CPT"}],"standard_charges":[{"minimum":490.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"STOMACH SURGERY PROCEDURE","code_information":[{"code":"43999","type":"CPT"}],"standard_charges":[{"minimum":601.63,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"FREEING OF BOWEL ADHESION","code_information":[{"code":"44005","type":"CPT"}],"standard_charges":[{"minimum":1137.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1137.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1137.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1137.58,"methodology":"fee schedule"}]}]},{"description":"INCISION OF SMALL BOWEL","code_information":[{"code":"44010","type":"CPT"}],"standard_charges":[{"minimum":889.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"}]}]},{"description":"INSERT NEEDLE CATH BOWEL","code_information":[{"code":"44015","type":"CPT"}],"standard_charges":[{"minimum":145.55,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"}]}]},{"description":"EXPLORE SMALL INTESTINE","code_information":[{"code":"44020","type":"CPT"}],"standard_charges":[{"minimum":1015.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.63,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS SMALL BOWEL","code_information":[{"code":"44021","type":"CPT"}],"standard_charges":[{"minimum":1012.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"}]}]},{"description":"INCISION OF LARGE BOWEL","code_information":[{"code":"44025","type":"CPT"}],"standard_charges":[{"minimum":1024.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.22,"methodology":"fee schedule"}]}]},{"description":"REDUCE BOWEL OBSTRUCTION","code_information":[{"code":"44050","type":"CPT"}],"standard_charges":[{"minimum":977.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.72,"methodology":"fee schedule"}]}]},{"description":"CORRECT MALROTATION OF BOWEL","code_information":[{"code":"44055","type":"CPT"}],"standard_charges":[{"minimum":1549.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1549.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1549.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1549.91,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF BOWEL","code_information":[{"code":"44100","type":"CPT"}],"standard_charges":[{"minimum":110.5,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTESTINE LESION(S)","code_information":[{"code":"44110","type":"CPT"}],"standard_charges":[{"minimum":889.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.39,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF BOWEL LESION(S)","code_information":[{"code":"44111","type":"CPT"}],"standard_charges":[{"minimum":1021,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SMALL INTESTINE","code_information":[{"code":"44120","type":"CPT"}],"standard_charges":[{"minimum":1272.4,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1272.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1272.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1272.4,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SMALL INTESTINE","code_information":[{"code":"44121","type":"CPT"}],"standard_charges":[{"minimum":248.54,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.54,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SMALL INTESTINE","code_information":[{"code":"44125","type":"CPT"}],"standard_charges":[{"minimum":1225.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1225.55,"methodology":"fee schedule"}]}]},{"description":"ENTERECTOMY W/O TAPER CONG","code_information":[{"code":"44126","type":"CPT"}],"standard_charges":[{"minimum":2565.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2565.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2565.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2565.9,"methodology":"fee schedule"}]}]},{"description":"ENTERECTOMY W/TAPER CONG","code_information":[{"code":"44127","type":"CPT"}],"standard_charges":[{"minimum":2961.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2961.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2961.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2961.43,"methodology":"fee schedule"}]}]},{"description":"ENTERECTOMY CONG ADD-ON","code_information":[{"code":"44128","type":"CPT"}],"standard_charges":[{"minimum":250.69,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"}]}]},{"description":"BOWEL TO BOWEL FUSION","code_information":[{"code":"44130","type":"CPT"}],"standard_charges":[{"minimum":1371.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.46,"methodology":"fee schedule"}]}]},{"description":"ENTERECTOMY CADAVER DONOR","code_information":[{"code":"44132","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENTERECTOMY LIVE DONOR","code_information":[{"code":"44133","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTESTINE TRANSPLNT CADAVER","code_information":[{"code":"44135","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTESTINE TRANSPLANT LIVE","code_information":[{"code":"44136","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE INTESTINAL ALLOGRAFT","code_information":[{"code":"44137","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MOBILIZATION OF COLON","code_information":[{"code":"44139","type":"CPT"}],"standard_charges":[{"minimum":124.09,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.09,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44140","type":"CPT"}],"standard_charges":[{"minimum":1397.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.92,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44141","type":"CPT"}],"standard_charges":[{"minimum":1885,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44143","type":"CPT"}],"standard_charges":[{"minimum":1716.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1716.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1716.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1716.92,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44144","type":"CPT"}],"standard_charges":[{"minimum":1832.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1832.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1832.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1832.79,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44145","type":"CPT"}],"standard_charges":[{"minimum":1715.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1715.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1715.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1715.13,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44146","type":"CPT"}],"standard_charges":[{"minimum":2179.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2179.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2179.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2179.68,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44147","type":"CPT"}],"standard_charges":[{"minimum":2006.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.23,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF COLON","code_information":[{"code":"44150","type":"CPT"}],"standard_charges":[{"minimum":1925.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1925.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1925.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1925.41,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF COLON/ILEOSTOMY","code_information":[{"code":"44151","type":"CPT"}],"standard_charges":[{"minimum":2234.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF COLON/ILEOSTOMY","code_information":[{"code":"44155","type":"CPT"}],"standard_charges":[{"minimum":2147.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2147.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2147.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2147.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF COLON/ILEOSTOMY","code_information":[{"code":"44156","type":"CPT"}],"standard_charges":[{"minimum":2387.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2387.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2387.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2387.81,"methodology":"fee schedule"}]}]},{"description":"COLECTOMY W/ILEOANAL ANAST","code_information":[{"code":"44157","type":"CPT"}],"standard_charges":[{"minimum":2270.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2270.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2270.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2270.51,"methodology":"fee schedule"}]}]},{"description":"COLECTOMY W/NEO-RECTUM POUCH","code_information":[{"code":"44158","type":"CPT"}],"standard_charges":[{"minimum":2327.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327.37,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF COLON","code_information":[{"code":"44160","type":"CPT"}],"standard_charges":[{"minimum":1293.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.86,"methodology":"fee schedule"}]}]},{"description":"LAP ENTEROLYSIS","code_information":[{"code":"44180","type":"CPT"}],"standard_charges":[{"minimum":960.56,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAP JEJUNOSTOMY","code_information":[{"code":"44186","type":"CPT"}],"standard_charges":[{"minimum":681.98,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAP ILEO/JEJUNO-STOMY","code_information":[{"code":"44187","type":"CPT"}],"standard_charges":[{"minimum":1136.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.86,"methodology":"fee schedule"}]}]},{"description":"LAP COLOSTOMY","code_information":[{"code":"44188","type":"CPT"}],"standard_charges":[{"minimum":1264.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.18,"methodology":"fee schedule"}]}]},{"description":"LAP ENTERECTOMY","code_information":[{"code":"44202","type":"CPT"}],"standard_charges":[{"minimum":1444.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1444.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1444.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1444.06,"methodology":"fee schedule"}]}]},{"description":"LAP RESECT S/INTESTINE ADDL","code_information":[{"code":"44203","type":"CPT"}],"standard_charges":[{"minimum":247.83,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"}]}]},{"description":"LAPARO PARTIAL COLECTOMY","code_information":[{"code":"44204","type":"CPT"}],"standard_charges":[{"minimum":1595.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1595.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1595.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1595.69,"methodology":"fee schedule"}]}]},{"description":"LAP COLECTOMY PART W/ILEUM","code_information":[{"code":"44205","type":"CPT"}],"standard_charges":[{"minimum":1386.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.12,"methodology":"fee schedule"}]}]},{"description":"LAP PART COLECTOMY W/STOMA","code_information":[{"code":"44206","type":"CPT"}],"standard_charges":[{"minimum":1807.4,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1807.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1807.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1807.4,"methodology":"fee schedule"}]}]},{"description":"L COLECTOMY/COLOPROCTOSTOMY","code_information":[{"code":"44207","type":"CPT"}],"standard_charges":[{"minimum":1878.2,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1878.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1878.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1878.2,"methodology":"fee schedule"}]}]},{"description":"L COLECTOMY/COLOPROCTOSTOMY","code_information":[{"code":"44208","type":"CPT"}],"standard_charges":[{"minimum":2044.85,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2044.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2044.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2044.85,"methodology":"fee schedule"}]}]},{"description":"LAPARO TOTAL PROCTOCOLECTOMY","code_information":[{"code":"44210","type":"CPT"}],"standard_charges":[{"minimum":1839.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1839.22,"methodology":"fee schedule"}]}]},{"description":"LAP COLECTOMY W/PROCTECTOMY","code_information":[{"code":"44211","type":"CPT"}],"standard_charges":[{"minimum":2197.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197.56,"methodology":"fee schedule"}]}]},{"description":"LAPARO TOTAL PROCTOCOLECTOMY","code_information":[{"code":"44212","type":"CPT"}],"standard_charges":[{"minimum":2102.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2102.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2102.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2102.07,"methodology":"fee schedule"}]}]},{"description":"LAP MOBIL SPLENIC FL ADD-ON","code_information":[{"code":"44213","type":"CPT"}],"standard_charges":[{"minimum":192.04,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"}]}]},{"description":"LAP CLOSE ENTEROSTOMY","code_information":[{"code":"44227","type":"CPT"}],"standard_charges":[{"minimum":1720.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1720.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1720.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1720.14,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC INTESTINE","code_information":[{"code":"44238","type":"CPT"}],"standard_charges":[{"minimum":3295.22,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"OPEN BOWEL TO SKIN","code_information":[{"code":"44300","type":"CPT"}],"standard_charges":[{"minimum":879.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"}]}]},{"description":"ILEOSTOMY/JEJUNOSTOMY","code_information":[{"code":"44310","type":"CPT"}],"standard_charges":[{"minimum":1083.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.58,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ILEOSTOMY","code_information":[{"code":"44312","type":"CPT"}],"standard_charges":[{"minimum":626.9,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ILEOSTOMY","code_information":[{"code":"44314","type":"CPT"}],"standard_charges":[{"minimum":1049.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.61,"methodology":"fee schedule"}]}]},{"description":"DEVISE BOWEL POUCH","code_information":[{"code":"44316","type":"CPT"}],"standard_charges":[{"minimum":1475.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.17,"methodology":"fee schedule"}]}]},{"description":"COLOSTOMY","code_information":[{"code":"44320","type":"CPT"}],"standard_charges":[{"minimum":1252.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.02,"methodology":"fee schedule"}]}]},{"description":"COLOSTOMY WITH BIOPSIES","code_information":[{"code":"44322","type":"CPT"}],"standard_charges":[{"minimum":1050.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"}]}]},{"description":"REVISION OF COLOSTOMY","code_information":[{"code":"44340","type":"CPT"}],"standard_charges":[{"minimum":661.59,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3940.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4019,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3979.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3999.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3901.94,"methodology":"fee schedule"}]}]},{"description":"REVISION OF COLOSTOMY","code_information":[{"code":"44345","type":"CPT"}],"standard_charges":[{"minimum":1097.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.17,"methodology":"fee schedule"}]}]},{"description":"REVISION OF COLOSTOMY","code_information":[{"code":"44346","type":"CPT"}],"standard_charges":[{"minimum":1233.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.42,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44360","type":"CPT"}],"standard_charges":[{"minimum":149.13,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY/BIOPSY","code_information":[{"code":"44361","type":"CPT"}],"standard_charges":[{"minimum":164.15,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44363","type":"CPT"}],"standard_charges":[{"minimum":198.48,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44364","type":"CPT"}],"standard_charges":[{"minimum":211.35,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44365","type":"CPT"}],"standard_charges":[{"minimum":188.82,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44366","type":"CPT"}],"standard_charges":[{"minimum":247.83,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44369","type":"CPT"}],"standard_charges":[{"minimum":253.91,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY/STENT","code_information":[{"code":"44370","type":"CPT"}],"standard_charges":[{"minimum":276.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":276.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44372","type":"CPT"}],"standard_charges":[{"minimum":247.47,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44373","type":"CPT"}],"standard_charges":[{"minimum":197.76,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44376","type":"CPT"}],"standard_charges":[{"minimum":293.25,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY/BIOPSY","code_information":[{"code":"44377","type":"CPT"}],"standard_charges":[{"minimum":309.34,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44378","type":"CPT"}],"standard_charges":[{"minimum":396.95,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"S BOWEL ENDOSCOPE W/STENT","code_information":[{"code":"44379","type":"CPT"}],"standard_charges":[{"minimum":423.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY BR/WA","code_information":[{"code":"44380","type":"CPT"}],"standard_charges":[{"minimum":60.08,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY BR/WA","code_information":[{"code":"44381","type":"CPT"}],"standard_charges":[{"minimum":88.33,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44382","type":"CPT"}],"standard_charges":[{"minimum":77.25,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44384","type":"CPT"}],"standard_charges":[{"minimum":158.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY OF BOWEL POUCH","code_information":[{"code":"44385","type":"CPT"}],"standard_charges":[{"minimum":76.17,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY BOWEL POUCH/BIOP","code_information":[{"code":"44386","type":"CPT"}],"standard_charges":[{"minimum":92.98,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY THRU STOMA SPX","code_information":[{"code":"44388","type":"CPT"}],"standard_charges":[{"minimum":161.64,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY WITH BIOPSY","code_information":[{"code":"44389","type":"CPT"}],"standard_charges":[{"minimum":177.74,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY FOR FOREIGN BODY","code_information":[{"code":"44390","type":"CPT"}],"standard_charges":[{"minimum":217.79,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY FOR BLEEDING","code_information":[{"code":"44391","type":"CPT"}],"standard_charges":[{"minimum":238.53,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY  POLYPECTOMY","code_information":[{"code":"44392","type":"CPT"}],"standard_charges":[{"minimum":206.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/SNARE","code_information":[{"code":"44394","type":"CPT"}],"standard_charges":[{"minimum":233.17,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY WITH ABLATION","code_information":[{"code":"44401","type":"CPT"}],"standard_charges":[{"minimum":250.69,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/STENT PLCMT","code_information":[{"code":"44402","type":"CPT"}],"standard_charges":[{"minimum":270.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/RESECTION","code_information":[{"code":"44403","type":"CPT"}],"standard_charges":[{"minimum":314.35,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/INJECTION","code_information":[{"code":"44404","type":"CPT"}],"standard_charges":[{"minimum":177.74,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/DILATION","code_information":[{"code":"44405","type":"CPT"}],"standard_charges":[{"minimum":189.89,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/ULTRASOUND","code_information":[{"code":"44406","type":"CPT"}],"standard_charges":[{"minimum":237.46,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/NDL ASPIR/BX","code_information":[{"code":"44407","type":"CPT"}],"standard_charges":[{"minimum":284.31,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/DECOMPRESSION","code_information":[{"code":"44408","type":"CPT"}],"standard_charges":[{"minimum":239.25,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"INTRO GASTROINTESTINAL TUBE","code_information":[{"code":"44500","type":"CPT"}],"standard_charges":[{"minimum":19.67,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":900.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":900.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"SUTURE SMALL INTESTINE","code_information":[{"code":"44602","type":"CPT"}],"standard_charges":[{"minimum":1461.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.22,"methodology":"fee schedule"}]}]},{"description":"SUTURE SMALL INTESTINE","code_information":[{"code":"44603","type":"CPT"}],"standard_charges":[{"minimum":1680.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1680.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1680.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1680.08,"methodology":"fee schedule"}]}]},{"description":"SUTURE LARGE INTESTINE","code_information":[{"code":"44604","type":"CPT"}],"standard_charges":[{"minimum":1097.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF BOWEL LESION","code_information":[{"code":"44605","type":"CPT"}],"standard_charges":[{"minimum":1339.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339.28,"methodology":"fee schedule"}]}]},{"description":"INTESTINAL STRICTUROPLASTY","code_information":[{"code":"44615","type":"CPT"}],"standard_charges":[{"minimum":1112.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.55,"methodology":"fee schedule"}]}]},{"description":"REPAIR BOWEL OPENING","code_information":[{"code":"44620","type":"CPT"}],"standard_charges":[{"minimum":901.19,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.19,"methodology":"fee schedule"}]}]},{"description":"REPAIR BOWEL OPENING","code_information":[{"code":"44625","type":"CPT"}],"standard_charges":[{"minimum":1052.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.82,"methodology":"fee schedule"}]}]},{"description":"REPAIR BOWEL OPENING","code_information":[{"code":"44626","type":"CPT"}],"standard_charges":[{"minimum":1650.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1650.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1650.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1650.76,"methodology":"fee schedule"}]}]},{"description":"REPAIR BOWEL-SKIN FISTULA","code_information":[{"code":"44640","type":"CPT"}],"standard_charges":[{"minimum":1450.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1450.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1450.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1450.49,"methodology":"fee schedule"}]}]},{"description":"REPAIR BOWEL FISTULA","code_information":[{"code":"44650","type":"CPT"}],"standard_charges":[{"minimum":1496.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1496.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1496.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1496.27,"methodology":"fee schedule"}]}]},{"description":"REPAIR BOWEL-BLADDER FISTULA","code_information":[{"code":"44660","type":"CPT"}],"standard_charges":[{"minimum":1396.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1396.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1396.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1396.49,"methodology":"fee schedule"}]}]},{"description":"REPAIR BOWEL-BLADDER FISTULA","code_information":[{"code":"44661","type":"CPT"}],"standard_charges":[{"minimum":1601.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1601.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1601.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1601.05,"methodology":"fee schedule"}]}]},{"description":"SURGICAL REVISION INTESTINE","code_information":[{"code":"44680","type":"CPT"}],"standard_charges":[{"minimum":1122.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1122.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1122.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1122.56,"methodology":"fee schedule"}]}]},{"description":"SUSPEND BOWEL W/PROSTHESIS","code_information":[{"code":"44700","type":"CPT"}],"standard_charges":[{"minimum":1045.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1045.31,"methodology":"fee schedule"}]}]},{"description":"INTRAOP COLON LAVAGE ADD-ON","code_information":[{"code":"44701","type":"CPT"}],"standard_charges":[{"minimum":174.87,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"}]}]},{"description":"PREPARE FECAL MICROBIOTA","code_information":[{"code":"44705","type":"CPT"}],"standard_charges":[{"minimum":74.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"}]}]},{"description":"PREPARE DONOR INTESTINE","code_information":[{"code":"44715","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR INTESTINE/VENOUS","code_information":[{"code":"44720","type":"CPT"}],"standard_charges":[{"minimum":281.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.8,"methodology":"fee schedule"}]}]},{"description":"PREP DONOR INTESTINE/ARTERY","code_information":[{"code":"44721","type":"CPT"}],"standard_charges":[{"minimum":394.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.09,"methodology":"fee schedule"}]}]},{"description":"UNLISTED PX SMALL INTESTINE","code_information":[{"code":"44799","type":"CPT"}],"standard_charges":[{"minimum":601.63,"maximum":4392.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF BOWEL POUCH","code_information":[{"code":"44800","type":"CPT"}],"standard_charges":[{"minimum":814.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":814.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":814.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":814.65,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF MESENTERY LESION","code_information":[{"code":"44820","type":"CPT"}],"standard_charges":[{"minimum":890.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF MESENTERY","code_information":[{"code":"44850","type":"CPT"}],"standard_charges":[{"minimum":783.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.18,"methodology":"fee schedule"}]}]},{"description":"BOWEL SURGERY PROCEDURE","code_information":[{"code":"44899","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAIN APPENDIX ABSCESS OPEN","code_information":[{"code":"44900","type":"CPT"}],"standard_charges":[{"minimum":820.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.37,"methodology":"fee schedule"}]}]},{"description":"APPENDECTOMY","code_information":[{"code":"44950","type":"CPT"}],"standard_charges":[{"minimum":671.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6716.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6849.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6783.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6816.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"}]}]},{"description":"APPENDECTOMY ADD-ON","code_information":[{"code":"44955","type":"CPT"}],"standard_charges":[{"minimum":86.54,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"}]}]},{"description":"APPENDECTOMY","code_information":[{"code":"44960","type":"CPT"}],"standard_charges":[{"minimum":915.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.86,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY APPENDECTOMY","code_information":[{"code":"44970","type":"CPT"}],"standard_charges":[{"minimum":632.27,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":632.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":632.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":632.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC APP","code_information":[{"code":"44979","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PELVIC ABSCESS","code_information":[{"code":"45000","type":"CPT"}],"standard_charges":[{"minimum":452.03,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF RECTAL ABSCESS","code_information":[{"code":"45005","type":"CPT"}],"standard_charges":[{"minimum":173.8,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF RECTAL ABSCESS","code_information":[{"code":"45020","type":"CPT"}],"standard_charges":[{"minimum":597.94,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF RECTUM","code_information":[{"code":"45100","type":"CPT"}],"standard_charges":[{"minimum":320.42,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ANORECTAL LESION","code_information":[{"code":"45108","type":"CPT"}],"standard_charges":[{"minimum":395.17,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RECTUM","code_information":[{"code":"45110","type":"CPT"}],"standard_charges":[{"minimum":1889.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1889.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1889.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1889.65,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF RECTUM","code_information":[{"code":"45111","type":"CPT"}],"standard_charges":[{"minimum":1135.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RECTUM","code_information":[{"code":"45112","type":"CPT"}],"standard_charges":[{"minimum":1887.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1887.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1887.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1887.14,"methodology":"fee schedule"}]}]},{"description":"PARTIAL PROCTECTOMY","code_information":[{"code":"45113","type":"CPT"}],"standard_charges":[{"minimum":1939.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1939.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1939.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1939.71,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF RECTUM","code_information":[{"code":"45114","type":"CPT"}],"standard_charges":[{"minimum":1890.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1890.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1890.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1890.01,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF RECTUM","code_information":[{"code":"45116","type":"CPT"}],"standard_charges":[{"minimum":1609.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1609.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1609.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1609.28,"methodology":"fee schedule"}]}]},{"description":"REMOVE RECTUM W/RESERVOIR","code_information":[{"code":"45119","type":"CPT"}],"standard_charges":[{"minimum":1954.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1954.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1954.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1954.02,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RECTUM","code_information":[{"code":"45120","type":"CPT"}],"standard_charges":[{"minimum":1668.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RECTUM AND COLON","code_information":[{"code":"45121","type":"CPT"}],"standard_charges":[{"minimum":1820.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1820.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1820.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1820.27,"methodology":"fee schedule"}]}]},{"description":"PARTIAL PROCTECTOMY","code_information":[{"code":"45123","type":"CPT"}],"standard_charges":[{"minimum":1161.18,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.18,"methodology":"fee schedule"}]}]},{"description":"PELVIC EXENTERATION","code_information":[{"code":"45126","type":"CPT"}],"standard_charges":[{"minimum":2853.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2853.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2853.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2853.78,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF RECTAL PROLAPSE","code_information":[{"code":"45130","type":"CPT"}],"standard_charges":[{"minimum":1131.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1131.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1131.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1131.14,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF RECTAL PROLAPSE","code_information":[{"code":"45135","type":"CPT"}],"standard_charges":[{"minimum":1354.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1354.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1354.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1354.65,"methodology":"fee schedule"}]}]},{"description":"EXCISE ILEOANAL RESERVIOR","code_information":[{"code":"45136","type":"CPT"}],"standard_charges":[{"minimum":1858.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1858.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1858.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1858.18,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF RECTAL STRICTURE","code_information":[{"code":"45150","type":"CPT"}],"standard_charges":[{"minimum":446.66,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF RECTAL LESION","code_information":[{"code":"45160","type":"CPT"}],"standard_charges":[{"minimum":1073.92,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"EXC RECT TUM TRANSANAL PART","code_information":[{"code":"45171","type":"CPT"}],"standard_charges":[{"minimum":648.72,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"EXC RECT TUM TRANSANAL FULL","code_information":[{"code":"45172","type":"CPT"}],"standard_charges":[{"minimum":864.36,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION RECTAL TUMOR","code_information":[{"code":"45190","type":"CPT"}],"standard_charges":[{"minimum":733.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY DX","code_information":[{"code":"45300","type":"CPT"}],"standard_charges":[{"minimum":50.42,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY DILATE","code_information":[{"code":"45303","type":"CPT"}],"standard_charges":[{"minimum":89.4,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY W/BX","code_information":[{"code":"45305","type":"CPT"}],"standard_charges":[{"minimum":76.17,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY FB","code_information":[{"code":"45307","type":"CPT"}],"standard_charges":[{"minimum":104.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY REMOVAL","code_information":[{"code":"45308","type":"CPT"}],"standard_charges":[{"minimum":88.33,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY REMOVAL","code_information":[{"code":"45309","type":"CPT"}],"standard_charges":[{"minimum":93.34,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY REMOVAL","code_information":[{"code":"45315","type":"CPT"}],"standard_charges":[{"minimum":110.15,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY BLEED","code_information":[{"code":"45317","type":"CPT"}],"standard_charges":[{"minimum":115.87,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY ABLATE","code_information":[{"code":"45320","type":"CPT"}],"standard_charges":[{"minimum":109.07,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY VOLVUL","code_information":[{"code":"45321","type":"CPT"}],"standard_charges":[{"minimum":107.64,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"PROCTOSIGMOIDOSCOPY W/STENT","code_information":[{"code":"45327","type":"CPT"}],"standard_charges":[{"minimum":121.59,"maximum":6534.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"DIAGNOSTIC SIGMOIDOSCOPY","code_information":[{"code":"45330","type":"CPT"}],"standard_charges":[{"minimum":59.01,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY AND BIOPSY","code_information":[{"code":"45331","type":"CPT"}],"standard_charges":[{"minimum":75.46,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY W/FB REMOVAL","code_information":[{"code":"45332","type":"CPT"}],"standard_charges":[{"minimum":109.79,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY  POLYPECTOMY","code_information":[{"code":"45333","type":"CPT"}],"standard_charges":[{"minimum":97.99,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY FOR BLEEDING","code_information":[{"code":"45334","type":"CPT"}],"standard_charges":[{"minimum":121.95,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY W/SUBMUC INJ","code_information":[{"code":"45335","type":"CPT"}],"standard_charges":[{"minimum":69.74,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY  DECOMPRESS","code_information":[{"code":"45337","type":"CPT"}],"standard_charges":[{"minimum":118.73,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY W/TUMR REMOVE","code_information":[{"code":"45338","type":"CPT"}],"standard_charges":[{"minimum":124.81,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"SIG W/TNDSC BALLOON DILATION","code_information":[{"code":"45340","type":"CPT"}],"standard_charges":[{"minimum":81.54,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY W/ULTRASOUND","code_information":[{"code":"45341","type":"CPT"}],"standard_charges":[{"minimum":128.74,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY W/US GUIDE BX","code_information":[{"code":"45342","type":"CPT"}],"standard_charges":[{"minimum":176.66,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY W/ABLATION","code_information":[{"code":"45346","type":"CPT"}],"standard_charges":[{"minimum":166.29,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY W/PLCMT STENT","code_information":[{"code":"45347","type":"CPT"}],"standard_charges":[{"minimum":159.5,"maximum":6534.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"SIGMOIDOSCOPY W/RESECTION","code_information":[{"code":"45349","type":"CPT"}],"standard_charges":[{"minimum":204.91,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"SGMDSC W/BAND LIGATION","code_information":[{"code":"45350","type":"CPT"}],"standard_charges":[{"minimum":105.14,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"DIAGNOSTIC COLONOSCOPY","code_information":[{"code":"45378","type":"CPT"}],"standard_charges":[{"minimum":190.97,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/FB REMOVAL","code_information":[{"code":"45379","type":"CPT"}],"standard_charges":[{"minimum":246.76,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY AND BIOPSY","code_information":[{"code":"45380","type":"CPT"}],"standard_charges":[{"minimum":207.78,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY SUBMUCOUS NJX","code_information":[{"code":"45381","type":"CPT"}],"standard_charges":[{"minimum":207.42,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/CONTROL BLEED","code_information":[{"code":"45382","type":"CPT"}],"standard_charges":[{"minimum":267.5,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/LESION REMOVAL","code_information":[{"code":"45384","type":"CPT"}],"standard_charges":[{"minimum":236.03,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/LESION REMOVAL","code_information":[{"code":"45385","type":"CPT"}],"standard_charges":[{"minimum":262.85,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/BALLOON DILAT","code_information":[{"code":"45386","type":"CPT"}],"standard_charges":[{"minimum":219.22,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/ABLATION","code_information":[{"code":"45388","type":"CPT"}],"standard_charges":[{"minimum":279.66,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/STENT PLCMT","code_information":[{"code":"45389","type":"CPT"}],"standard_charges":[{"minimum":299.33,"maximum":6534.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6534.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6471.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6503.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6344.62,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/RESECTION","code_information":[{"code":"45390","type":"CPT"}],"standard_charges":[{"minimum":343.67,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/ENDOSCOPE US","code_information":[{"code":"45391","type":"CPT"}],"standard_charges":[{"minimum":266.42,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/ENDOSCOPIC FNB","code_information":[{"code":"45392","type":"CPT"}],"standard_charges":[{"minimum":314.35,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/DECOMPRESSION","code_information":[{"code":"45393","type":"CPT"}],"standard_charges":[{"minimum":259.99,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"LAP REMOVAL OF RECTUM","code_information":[{"code":"45395","type":"CPT"}],"standard_charges":[{"minimum":2033.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.05,"methodology":"fee schedule"}]}]},{"description":"LAP REMOVE RECTUM W/POUCH","code_information":[{"code":"45397","type":"CPT"}],"standard_charges":[{"minimum":2202.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2202.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2202.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2202.21,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/BAND LIGATION","code_information":[{"code":"45398","type":"CPT"}],"standard_charges":[{"minimum":243.54,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"UNLISTED PROCEDURE COLON","code_information":[{"code":"45399","type":"CPT"}],"standard_charges":[{"minimum":589.79,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPIC PROC","code_information":[{"code":"45400","type":"CPT"}],"standard_charges":[{"minimum":1180.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1180.49,"methodology":"fee schedule"}]}]},{"description":"LAP PROCTOPEXY W/SIG RESECT","code_information":[{"code":"45402","type":"CPT"}],"standard_charges":[{"minimum":1576.73,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1576.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1576.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1576.73,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC RECTUM","code_information":[{"code":"45499","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF RECTUM","code_information":[{"code":"45500","type":"CPT"}],"standard_charges":[{"minimum":598.65,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF RECTUM","code_information":[{"code":"45505","type":"CPT"}],"standard_charges":[{"minimum":634.05,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF RECTAL PROLAPSE","code_information":[{"code":"45520","type":"CPT"}],"standard_charges":[{"minimum":42.56,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"CORRECT RECTAL PROLAPSE","code_information":[{"code":"45540","type":"CPT"}],"standard_charges":[{"minimum":1095.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.74,"methodology":"fee schedule"}]}]},{"description":"CORRECT RECTAL PROLAPSE","code_information":[{"code":"45541","type":"CPT"}],"standard_charges":[{"minimum":981.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR RECTUM/REMOVE SIGMOID","code_information":[{"code":"45550","type":"CPT"}],"standard_charges":[{"minimum":1512.36,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.36,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF RECTOCELE","code_information":[{"code":"45560","type":"CPT"}],"standard_charges":[{"minimum":726.32,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":726.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":726.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":726.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION/REPAIR OF RECTUM","code_information":[{"code":"45562","type":"CPT"}],"standard_charges":[{"minimum":1220.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1220.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1220.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1220.55,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION/REPAIR OF RECTUM","code_information":[{"code":"45563","type":"CPT"}],"standard_charges":[{"minimum":1726.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1726.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1726.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1726.57,"methodology":"fee schedule"}]}]},{"description":"REPAIR RECT/BLADDER FISTULA","code_information":[{"code":"45800","type":"CPT"}],"standard_charges":[{"minimum":1325.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.69,"methodology":"fee schedule"}]}]},{"description":"REPAIR FISTULA W/COLOSTOMY","code_information":[{"code":"45805","type":"CPT"}],"standard_charges":[{"minimum":1529.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1529.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1529.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1529.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR RECTOURETHRAL FISTULA","code_information":[{"code":"45820","type":"CPT"}],"standard_charges":[{"minimum":1329.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329.26,"methodology":"fee schedule"}]}]},{"description":"REPAIR FISTULA W/COLOSTOMY","code_information":[{"code":"45825","type":"CPT"}],"standard_charges":[{"minimum":1601.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1601.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1601.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1601.77,"methodology":"fee schedule"}]}]},{"description":"REDUCTION OF RECTAL PROLAPSE","code_information":[{"code":"45900","type":"CPT"}],"standard_charges":[{"minimum":223.15,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"DILATION OF ANAL SPHINCTER","code_information":[{"code":"45905","type":"CPT"}],"standard_charges":[{"minimum":179.52,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"DILATION OF RECTAL NARROWING","code_information":[{"code":"45910","type":"CPT"}],"standard_charges":[{"minimum":203.48,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"REMOVE RECTAL OBSTRUCTION","code_information":[{"code":"45915","type":"CPT"}],"standard_charges":[{"minimum":240.32,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"SURG DX EXAM ANORECTAL","code_information":[{"code":"45990","type":"CPT"}],"standard_charges":[{"minimum":110.5,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"RECTUM SURGERY PROCEDURE","code_information":[{"code":"45999","type":"CPT"}],"standard_charges":[{"minimum":589.79,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"PLACEMENT OF SETON","code_information":[{"code":"46020","type":"CPT"}],"standard_charges":[{"minimum":122.31,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RECTAL MARKER","code_information":[{"code":"46030","type":"CPT"}],"standard_charges":[{"minimum":90.48,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"INCISION OF RECTAL ABSCESS","code_information":[{"code":"46040","type":"CPT"}],"standard_charges":[{"minimum":449.52,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"INCISION OF RECTAL ABSCESS","code_information":[{"code":"46045","type":"CPT"}],"standard_charges":[{"minimum":464.19,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":464.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"INCISION OF ANAL ABSCESS","code_information":[{"code":"46050","type":"CPT"}],"standard_charges":[{"minimum":107.29,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"INCISION OF RECTAL ABSCESS","code_information":[{"code":"46060","type":"CPT"}],"standard_charges":[{"minimum":513.9,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"INCISION OF ANAL SEPTUM","code_information":[{"code":"46070","type":"CPT"}],"standard_charges":[{"minimum":286.09,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"INCISION OF ANAL SPHINCTER","code_information":[{"code":"46080","type":"CPT"}],"standard_charges":[{"minimum":165.58,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"INCISE EXTERNAL HEMORRHOID","code_information":[{"code":"46083","type":"CPT"}],"standard_charges":[{"minimum":116.23,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ANAL FISSURE","code_information":[{"code":"46200","type":"CPT"}],"standard_charges":[{"minimum":358.33,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"EXCISE ANAL EXT TAG/PAPILLA","code_information":[{"code":"46220","type":"CPT"}],"standard_charges":[{"minimum":128.38,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF HEMORRHOID(S)","code_information":[{"code":"46221","type":"CPT"}],"standard_charges":[{"minimum":202.77,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF ANAL TAGS","code_information":[{"code":"46230","type":"CPT"}],"standard_charges":[{"minimum":183.1,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE EXT HEM GROUPS 2+","code_information":[{"code":"46250","type":"CPT"}],"standard_charges":[{"minimum":336.16,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE INT/EXT HEM 1 GROUP","code_information":[{"code":"46255","type":"CPT"}],"standard_charges":[{"minimum":374.07,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE IN/EX HEM GRP  FISS","code_information":[{"code":"46257","type":"CPT"}],"standard_charges":[{"minimum":440.58,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE IN/EX HEM GRP W/FISTU","code_information":[{"code":"46258","type":"CPT"}],"standard_charges":[{"minimum":508.53,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE IN/EX HEM GROUPS 2+","code_information":[{"code":"46260","type":"CPT"}],"standard_charges":[{"minimum":507.82,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE IN/EX HEM GRPS  FISS","code_information":[{"code":"46261","type":"CPT"}],"standard_charges":[{"minimum":562.53,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE IN/EX HEM GRPS W/FIST","code_information":[{"code":"46262","type":"CPT"}],"standard_charges":[{"minimum":616.53,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE ANAL FIST SUBQ","code_information":[{"code":"46270","type":"CPT"}],"standard_charges":[{"minimum":423.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE ANAL FIST INTER","code_information":[{"code":"46275","type":"CPT"}],"standard_charges":[{"minimum":446.66,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE ANAL FIST COMPLEX","code_information":[{"code":"46280","type":"CPT"}],"standard_charges":[{"minimum":507.46,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE ANAL FIST 2 STAGE","code_information":[{"code":"46285","type":"CPT"}],"standard_charges":[{"minimum":448.09,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR ANAL FISTULA","code_information":[{"code":"46288","type":"CPT"}],"standard_charges":[{"minimum":589.71,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HEMORRHOID CLOT","code_information":[{"code":"46320","type":"CPT"}],"standard_charges":[{"minimum":119.8,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"INJECTION INTO HEMORRHOID(S)","code_information":[{"code":"46500","type":"CPT"}],"standard_charges":[{"minimum":193.47,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERVATION ANAL MUSC","code_information":[{"code":"46505","type":"CPT"}],"standard_charges":[{"minimum":263.92,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"DIAGNOSTIC ANOSCOPY SPX","code_information":[{"code":"46600","type":"CPT"}],"standard_charges":[{"minimum":43.27,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"DIAGNOSTIC ANOSCOPY","code_information":[{"code":"46601","type":"CPT"}],"standard_charges":[{"minimum":97.99,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY AND DILATION","code_information":[{"code":"46604","type":"CPT"}],"standard_charges":[{"minimum":69.02,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY AND BIOPSY","code_information":[{"code":"46606","type":"CPT"}],"standard_charges":[{"minimum":79.03,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"DIAGNOSTIC ANOSCOPY  BIOPSY","code_information":[{"code":"46607","type":"CPT"}],"standard_charges":[{"minimum":130.17,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY REMOVE FOR BODY","code_information":[{"code":"46608","type":"CPT"}],"standard_charges":[{"minimum":88.33,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY REMOVE LESION","code_information":[{"code":"46610","type":"CPT"}],"standard_charges":[{"minimum":83.68,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY","code_information":[{"code":"46611","type":"CPT"}],"standard_charges":[{"minimum":84.4,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY REMOVE LESIONS","code_information":[{"code":"46612","type":"CPT"}],"standard_charges":[{"minimum":99.42,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY CONTROL BLEEDING","code_information":[{"code":"46614","type":"CPT"}],"standard_charges":[{"minimum":67.59,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY","code_information":[{"code":"46615","type":"CPT"}],"standard_charges":[{"minimum":94.77,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANAL STRICTURE","code_information":[{"code":"46700","type":"CPT"}],"standard_charges":[{"minimum":687.7,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANAL STRICTURE","code_information":[{"code":"46705","type":"CPT"}],"standard_charges":[{"minimum":601.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.15,"methodology":"fee schedule"}]}]},{"description":"REPR OF ANAL FISTULA W/GLUE","code_information":[{"code":"46706","type":"CPT"}],"standard_charges":[{"minimum":189.54,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR ANORECTAL FIST W/PLUG","code_information":[{"code":"46707","type":"CPT"}],"standard_charges":[{"minimum":530.7,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPR PER/VAG POUCH SNGL PROC","code_information":[{"code":"46710","type":"CPT"}],"standard_charges":[{"minimum":1160.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"}]}]},{"description":"REPR PER/VAG POUCH DBL PROC","code_information":[{"code":"46712","type":"CPT"}],"standard_charges":[{"minimum":2304.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.13,"methodology":"fee schedule"}]}]},{"description":"REP PERF ANOPER FISTU","code_information":[{"code":"46715","type":"CPT"}],"standard_charges":[{"minimum":583.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"}]}]},{"description":"REP PERF ANOPER/VESTIB FISTU","code_information":[{"code":"46716","type":"CPT"}],"standard_charges":[{"minimum":1295.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1295.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1295.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1295.29,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCTION OF ABSENT ANUS","code_information":[{"code":"46730","type":"CPT"}],"standard_charges":[{"minimum":2077.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2077.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2077.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2077.75,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCTION OF ABSENT ANUS","code_information":[{"code":"46735","type":"CPT"}],"standard_charges":[{"minimum":2388.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2388.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2388.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2388.17,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCTION OF ABSENT ANUS","code_information":[{"code":"46740","type":"CPT"}],"standard_charges":[{"minimum":2265.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2265.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2265.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2265.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF IMPERFORATED ANUS","code_information":[{"code":"46742","type":"CPT"}],"standard_charges":[{"minimum":2614.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2614.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2614.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2614.18,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF CLOACAL ANOMALY","code_information":[{"code":"46744","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3678.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3678.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3678.09,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF CLOACAL ANOMALY","code_information":[{"code":"46746","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4049.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4049.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4049.65,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF CLOACAL ANOMALY","code_information":[{"code":"46748","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4386.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4386.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4386.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANAL SPHINCTER","code_information":[{"code":"46750","type":"CPT"}],"standard_charges":[{"minimum":786.4,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANAL SPHINCTER","code_information":[{"code":"46751","type":"CPT"}],"standard_charges":[{"minimum":702.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.72,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF ANUS","code_information":[{"code":"46753","type":"CPT"}],"standard_charges":[{"minimum":650.51,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SUTURE FROM ANUS","code_information":[{"code":"46754","type":"CPT"}],"standard_charges":[{"minimum":256.41,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANAL SPHINCTER","code_information":[{"code":"46760","type":"CPT"}],"standard_charges":[{"minimum":1157.61,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1157.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1157.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1157.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ANAL SPHINCTER","code_information":[{"code":"46761","type":"CPT"}],"standard_charges":[{"minimum":956.98,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION ANAL LESION(S)","code_information":[{"code":"46900","type":"CPT"}],"standard_charges":[{"minimum":145.19,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION ANAL LESION(S)","code_information":[{"code":"46910","type":"CPT"}],"standard_charges":[{"minimum":143.05,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"CRYOSURGERY ANAL LESION(S)","code_information":[{"code":"46916","type":"CPT"}],"standard_charges":[{"minimum":149.84,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"LASER SURGERY ANAL LESIONS","code_information":[{"code":"46917","type":"CPT"}],"standard_charges":[{"minimum":136.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF ANAL LESION(S)","code_information":[{"code":"46922","type":"CPT"}],"standard_charges":[{"minimum":145.55,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION ANAL LESION(S)","code_information":[{"code":"46924","type":"CPT"}],"standard_charges":[{"minimum":190.97,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"DESTROY INTERNAL HEMORRHOIDS","code_information":[{"code":"46930","type":"CPT"}],"standard_charges":[{"minimum":160.21,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANAL FISSURE","code_information":[{"code":"46940","type":"CPT"}],"standard_charges":[{"minimum":152.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF ANAL FISSURE","code_information":[{"code":"46942","type":"CPT"}],"standard_charges":[{"minimum":137.32,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"INT HRHC LIG 1 HROID W/O IMG","code_information":[{"code":"46945","type":"CPT"}],"standard_charges":[{"minimum":359.05,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"INT HRHC LIG 2+HROID W/O IMG","code_information":[{"code":"46946","type":"CPT"}],"standard_charges":[{"minimum":401.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"HEMORRHOIDOPEXY BY STAPLING","code_information":[{"code":"46947","type":"CPT"}],"standard_charges":[{"minimum":410.54,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"INT HRHC TRANAL DARTLZJ 2+","code_information":[{"code":"46948","type":"CPT"}],"standard_charges":[{"minimum":467.41,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2952.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2981.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2995.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2922.89,"methodology":"fee schedule"}]}]},{"description":"ANUS SURGERY PROCEDURE","code_information":[{"code":"46999","type":"CPT"}],"standard_charges":[{"minimum":589.79,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":981.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1000.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":991.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":996.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":971.72,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BIOPSY OF LIVER","code_information":[{"code":"47000","type":"CPT"}],"standard_charges":[{"minimum":90.83,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BIOPSY LIVER ADD-ON","code_information":[{"code":"47001","type":"CPT"}],"standard_charges":[{"minimum":106.57,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"}]}]},{"description":"OPEN DRAINAGE LIVER LESION","code_information":[{"code":"47010","type":"CPT"}],"standard_charges":[{"minimum":1266.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"}]}]},{"description":"INJECT/ASPIRATE LIVER CYST","code_information":[{"code":"47015","type":"CPT"}],"standard_charges":[{"minimum":1215.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1215.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1215.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1215.9,"methodology":"fee schedule"}]}]},{"description":"WEDGE BIOPSY OF LIVER","code_information":[{"code":"47100","type":"CPT"}],"standard_charges":[{"minimum":890.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":890.11,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LIVER","code_information":[{"code":"47120","type":"CPT"}],"standard_charges":[{"minimum":2430.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2430.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2430.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2430.72,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE REMOVAL OF LIVER","code_information":[{"code":"47122","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3546.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3546.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3546.49,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LIVER","code_information":[{"code":"47125","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3193.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3193.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3193.88,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF LIVER","code_information":[{"code":"47130","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3426.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3426.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3426.69,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF DONOR LIVER","code_information":[{"code":"47133","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANTATION OF LIVER","code_information":[{"code":"47135","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5613.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5613.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5613.16,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL DONOR LIVER","code_information":[{"code":"47140","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3718.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3718.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3718.5,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL DONOR LIVER","code_information":[{"code":"47141","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4441.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4441.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4441.6,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL DONOR LIVER","code_information":[{"code":"47142","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4888.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4888.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4888.62,"methodology":"fee schedule"}]}]},{"description":"PREP DONOR LIVER WHOLE","code_information":[{"code":"47143","type":"CPT"}],"standard_charges":[{"minimum":211.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.07,"methodology":"fee schedule"}]}]},{"description":"PREP DONOR LIVER 3-SEGMENT","code_information":[{"code":"47144","type":"CPT"}],"standard_charges":[{"minimum":360.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.95,"methodology":"fee schedule"}]}]},{"description":"PREP DONOR LIVER LOBE SPLIT","code_information":[{"code":"47145","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR LIVER/VENOUS","code_information":[{"code":"47146","type":"CPT"}],"standard_charges":[{"minimum":337.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"}]}]},{"description":"PREP DONOR LIVER/ARTERIAL","code_information":[{"code":"47147","type":"CPT"}],"standard_charges":[{"minimum":394.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.09,"methodology":"fee schedule"}]}]},{"description":"SURGERY FOR LIVER LESION","code_information":[{"code":"47300","type":"CPT"}],"standard_charges":[{"minimum":1187.29,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1187.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1187.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1187.29,"methodology":"fee schedule"}]}]},{"description":"REPAIR LIVER WOUND","code_information":[{"code":"47350","type":"CPT"}],"standard_charges":[{"minimum":1421.53,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR LIVER WOUND","code_information":[{"code":"47360","type":"CPT"}],"standard_charges":[{"minimum":1949.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1949.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1949.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1949.01,"methodology":"fee schedule"}]}]},{"description":"REPAIR LIVER WOUND","code_information":[{"code":"47361","type":"CPT"}],"standard_charges":[{"minimum":3120.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3120.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3120.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3120.21,"methodology":"fee schedule"}]}]},{"description":"REPAIR LIVER WOUND","code_information":[{"code":"47362","type":"CPT"}],"standard_charges":[{"minimum":1511.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1511.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1511.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1511.29,"methodology":"fee schedule"}]}]},{"description":"LAPARO ABLATE LIVER TUMOR RF","code_information":[{"code":"47370","type":"CPT"}],"standard_charges":[{"minimum":1309.24,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO ABLATE LIVER CRYOSURG","code_information":[{"code":"47371","type":"CPT"}],"standard_charges":[{"minimum":1314.24,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1314.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1314.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1314.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROCEDURE LIVER","code_information":[{"code":"47379","type":"CPT"}],"standard_charges":[{"minimum":3295.22,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"OPEN ABLATE LIVER TUMOR RF","code_information":[{"code":"47380","type":"CPT"}],"standard_charges":[{"minimum":1508.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1508.79,"methodology":"fee schedule"}]}]},{"description":"OPEN ABLATE LIVER TUMOR CRYO","code_information":[{"code":"47381","type":"CPT"}],"standard_charges":[{"minimum":1543.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1543.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1543.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1543.83,"methodology":"fee schedule"}]}]},{"description":"PERCUT ABLATE LIVER RF","code_information":[{"code":"47382","type":"CPT"}],"standard_charges":[{"minimum":756.72,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PERQ ABLTJ LVR CRYOABLATION","code_information":[{"code":"47383","type":"CPT"}],"standard_charges":[{"minimum":460.97,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LIVER SURGERY PROCEDURE","code_information":[{"code":"47399","type":"CPT"}],"standard_charges":[{"minimum":462.2,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"INCISION OF LIVER DUCT","code_information":[{"code":"47400","type":"CPT"}],"standard_charges":[{"minimum":2234.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.39,"methodology":"fee schedule"}]}]},{"description":"INCISION OF BILE DUCT","code_information":[{"code":"47420","type":"CPT"}],"standard_charges":[{"minimum":1396.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1396.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1396.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1396.85,"methodology":"fee schedule"}]}]},{"description":"INCISION OF BILE DUCT","code_information":[{"code":"47425","type":"CPT"}],"standard_charges":[{"minimum":1425.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1425.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1425.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1425.46,"methodology":"fee schedule"}]}]},{"description":"INCISE BILE DUCT SPHINCTER","code_information":[{"code":"47460","type":"CPT"}],"standard_charges":[{"minimum":1324.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1324.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1324.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1324.26,"methodology":"fee schedule"}]}]},{"description":"INCISION OF GALLBLADDER","code_information":[{"code":"47480","type":"CPT"}],"standard_charges":[{"minimum":917.29,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.29,"methodology":"fee schedule"}]}]},{"description":"INCISION OF GALLBLADDER","code_information":[{"code":"47490","type":"CPT"}],"standard_charges":[{"minimum":343.67,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR CHOLANGIOGRAM","code_information":[{"code":"47531","type":"CPT"}],"standard_charges":[{"minimum":72.6,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR CHOLANGIOGRAM","code_information":[{"code":"47532","type":"CPT"}],"standard_charges":[{"minimum":216,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"PLMT BILIARY DRAINAGE CATH","code_information":[{"code":"47533","type":"CPT"}],"standard_charges":[{"minimum":268.93,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"PLMT BILIARY DRAINAGE CATH","code_information":[{"code":"47534","type":"CPT"}],"standard_charges":[{"minimum":376.21,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"CONVERSION EXT BIL DRG CATH","code_information":[{"code":"47535","type":"CPT"}],"standard_charges":[{"minimum":199.91,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"EXCHANGE BILIARY DRG CATH","code_information":[{"code":"47536","type":"CPT"}],"standard_charges":[{"minimum":134.82,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL BILIARY DRG CATH","code_information":[{"code":"47537","type":"CPT"}],"standard_charges":[{"minimum":98.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"PERQ PLMT BILE DUCT STENT","code_information":[{"code":"47538","type":"CPT"}],"standard_charges":[{"minimum":239.25,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PERQ PLMT BILE DUCT STENT","code_information":[{"code":"47539","type":"CPT"}],"standard_charges":[{"minimum":434.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PERQ PLMT BILE DUCT STENT","code_information":[{"code":"47540","type":"CPT"}],"standard_charges":[{"minimum":447.38,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PLMT ACCESS BIL TREE SM BWL","code_information":[{"code":"47541","type":"CPT"}],"standard_charges":[{"minimum":342.6,"maximum":6849.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6716.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6849.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6783.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6816.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"}]}]},{"description":"DILATE BILIARY DUCT/AMPULLA","code_information":[{"code":"47542","type":"CPT"}],"standard_charges":[{"minimum":138.4,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.4,"methodology":"fee schedule"}]}]},{"description":"ENDOLUMINAL BX BILIARY TREE","code_information":[{"code":"47543","type":"CPT"}],"standard_charges":[{"minimum":145.91,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.91,"methodology":"fee schedule"}]}]},{"description":"REMOVAL DUCT GLBLDR CALCULI","code_information":[{"code":"47544","type":"CPT"}],"standard_charges":[{"minimum":159.5,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"}]}]},{"description":"BILE DUCT ENDOSCOPY ADD-ON","code_information":[{"code":"47550","type":"CPT"}],"standard_charges":[{"minimum":168.8,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"}]}]},{"description":"BILIARY ENDO PERQ DX W/SPECI","code_information":[{"code":"47552","type":"CPT"}],"standard_charges":[{"minimum":286.09,"maximum":6849.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6716.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6849.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6783.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6816.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"}]}]},{"description":"BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"47553","type":"CPT"}],"standard_charges":[{"minimum":286.45,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6716.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6849.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6783.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6816.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"}]}]},{"description":"BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"47554","type":"CPT"}],"standard_charges":[{"minimum":460.61,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"47555","type":"CPT"}],"standard_charges":[{"minimum":341.17,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"47556","type":"CPT"}],"standard_charges":[{"minimum":386.58,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY","code_information":[{"code":"47562","type":"CPT"}],"standard_charges":[{"minimum":692.35,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO CHOLECYSTECTOMY/GRAPH","code_information":[{"code":"47563","type":"CPT"}],"standard_charges":[{"minimum":752.78,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO CHOLECYSTECTOMY/EXPLR","code_information":[{"code":"47564","type":"CPT"}],"standard_charges":[{"minimum":1169.77,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO CHOLECYSTOENTEROSTOMY","code_information":[{"code":"47570","type":"CPT"}],"standard_charges":[{"minimum":812.15,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.15,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC BILIARY","code_information":[{"code":"47579","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47600","type":"CPT"}],"standard_charges":[{"minimum":1118.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.63,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47605","type":"CPT"}],"standard_charges":[{"minimum":1177.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.28,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47610","type":"CPT"}],"standard_charges":[{"minimum":1302.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.44,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47612","type":"CPT"}],"standard_charges":[{"minimum":1327.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1327.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1327.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1327.12,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47620","type":"CPT"}],"standard_charges":[{"minimum":1432.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1432.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1432.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1432.61,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF BILE DUCTS","code_information":[{"code":"47700","type":"CPT"}],"standard_charges":[{"minimum":1107.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1107.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1107.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1107.9,"methodology":"fee schedule"}]}]},{"description":"BILE DUCT REVISION","code_information":[{"code":"47701","type":"CPT"}],"standard_charges":[{"minimum":1808.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1808.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1808.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1808.11,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF BILE DUCT TUMOR","code_information":[{"code":"47711","type":"CPT"}],"standard_charges":[{"minimum":1624.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1624.65,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF BILE DUCT TUMOR","code_information":[{"code":"47712","type":"CPT"}],"standard_charges":[{"minimum":2075.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2075.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2075.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2075.25,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF BILE DUCT CYST","code_information":[{"code":"47715","type":"CPT"}],"standard_charges":[{"minimum":1388.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1388.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1388.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1388.63,"methodology":"fee schedule"}]}]},{"description":"FUSE GALLBLADDER  BOWEL","code_information":[{"code":"47720","type":"CPT"}],"standard_charges":[{"minimum":1206.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1206.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1206.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1206.96,"methodology":"fee schedule"}]}]},{"description":"FUSE UPPER GI STRUCTURES","code_information":[{"code":"47721","type":"CPT"}],"standard_charges":[{"minimum":1413.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1413.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1413.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1413.66,"methodology":"fee schedule"}]}]},{"description":"FUSE GALLBLADDER  BOWEL","code_information":[{"code":"47740","type":"CPT"}],"standard_charges":[{"minimum":1370.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1370.39,"methodology":"fee schedule"}]}]},{"description":"FUSE GALLBLADDER  BOWEL","code_information":[{"code":"47741","type":"CPT"}],"standard_charges":[{"minimum":1538.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1538.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1538.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1538.47,"methodology":"fee schedule"}]}]},{"description":"FUSE BILE DUCTS AND BOWEL","code_information":[{"code":"47760","type":"CPT"}],"standard_charges":[{"minimum":2343.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2343.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2343.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2343.82,"methodology":"fee schedule"}]}]},{"description":"FUSE LIVER DUCTS  BOWEL","code_information":[{"code":"47765","type":"CPT"}],"standard_charges":[{"minimum":3145.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145.24,"methodology":"fee schedule"}]}]},{"description":"FUSE BILE DUCTS AND BOWEL","code_information":[{"code":"47780","type":"CPT"}],"standard_charges":[{"minimum":2574.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2574.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2574.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2574.13,"methodology":"fee schedule"}]}]},{"description":"FUSE BILE DUCTS AND BOWEL","code_information":[{"code":"47785","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3360.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3360.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3360.88,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF BILE DUCTS","code_information":[{"code":"47800","type":"CPT"}],"standard_charges":[{"minimum":1621.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1621.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1621.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1621.79,"methodology":"fee schedule"}]}]},{"description":"PLACEMENT BILE DUCT SUPPORT","code_information":[{"code":"47801","type":"CPT"}],"standard_charges":[{"minimum":1165.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.47,"methodology":"fee schedule"}]}]},{"description":"FUSE LIVER DUCT  INTESTINE","code_information":[{"code":"47802","type":"CPT"}],"standard_charges":[{"minimum":1589.25,"maximum":1589.25,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1589.25,"methodology":"fee schedule"}]}]},{"description":"SUTURE BILE DUCT INJURY","code_information":[{"code":"47900","type":"CPT"}],"standard_charges":[{"minimum":1438.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1438.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1438.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1438.69,"methodology":"fee schedule"}]}]},{"description":"BILE TRACT SURGERY PROCEDURE","code_information":[{"code":"47999","type":"CPT"}],"standard_charges":[{"minimum":601.63,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF ABDOMEN","code_information":[{"code":"48000","type":"CPT"}],"standard_charges":[{"minimum":1957.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1957.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1957.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1957.6,"methodology":"fee schedule"}]}]},{"description":"PLACEMENT OF DRAIN PANCREAS","code_information":[{"code":"48001","type":"CPT"}],"standard_charges":[{"minimum":2394.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2394.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2394.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2394.96,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PANCREATIC STONE","code_information":[{"code":"48020","type":"CPT"}],"standard_charges":[{"minimum":1232.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF PANCREAS OPEN","code_information":[{"code":"48100","type":"CPT"}],"standard_charges":[{"minimum":933.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.02,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BIOPSY PANCREAS","code_information":[{"code":"48102","type":"CPT"}],"standard_charges":[{"minimum":243.18,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"RESECT/DEBRIDE PANCREAS","code_information":[{"code":"48105","type":"CPT"}],"standard_charges":[{"minimum":2930.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2930.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2930.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2930.67,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PANCREAS LESION","code_information":[{"code":"48120","type":"CPT"}],"standard_charges":[{"minimum":1162.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.26,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF PANCREAS","code_information":[{"code":"48140","type":"CPT"}],"standard_charges":[{"minimum":1633.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1633.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1633.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1633.24,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF PANCREAS","code_information":[{"code":"48145","type":"CPT"}],"standard_charges":[{"minimum":1700.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1700.83,"methodology":"fee schedule"}]}]},{"description":"PANCREATECTOMY","code_information":[{"code":"48146","type":"CPT"}],"standard_charges":[{"minimum":1962.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1962.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1962.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1962.24,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PANCREATIC DUCT","code_information":[{"code":"48148","type":"CPT"}],"standard_charges":[{"minimum":1305.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.66,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF PANCREAS","code_information":[{"code":"48150","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3239.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3239.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3239.65,"methodology":"fee schedule"}]}]},{"description":"PANCREATECTOMY","code_information":[{"code":"48152","type":"CPT"}],"standard_charges":[{"minimum":2997.19,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2997.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2997.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2997.19,"methodology":"fee schedule"}]}]},{"description":"PANCREATECTOMY","code_information":[{"code":"48153","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3225.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3225.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3225.35,"methodology":"fee schedule"}]}]},{"description":"PANCREATECTOMY","code_information":[{"code":"48154","type":"CPT"}],"standard_charges":[{"minimum":3010.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3010.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3010.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3010.42,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PANCREAS","code_information":[{"code":"48155","type":"CPT"}],"standard_charges":[{"minimum":1896.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1896.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1896.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1896.09,"methodology":"fee schedule"}]}]},{"description":"PANCREAS REMOVAL/TRANSPLANT","code_information":[{"code":"48160","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INJECTION INTRAOP ADD-ON","code_information":[{"code":"48400","type":"CPT"}],"standard_charges":[{"minimum":109.79,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"}]}]},{"description":"SURGERY OF PANCREATIC CYST","code_information":[{"code":"48500","type":"CPT"}],"standard_charges":[{"minimum":1201.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1201.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1201.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1201.24,"methodology":"fee schedule"}]}]},{"description":"DRAIN PANCREATIC PSEUDOCYST","code_information":[{"code":"48510","type":"CPT"}],"standard_charges":[{"minimum":1146.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.16,"methodology":"fee schedule"}]}]},{"description":"FUSE PANCREAS CYST AND BOWEL","code_information":[{"code":"48520","type":"CPT"}],"standard_charges":[{"minimum":1147.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.59,"methodology":"fee schedule"}]}]},{"description":"FUSE PANCREAS CYST AND BOWEL","code_information":[{"code":"48540","type":"CPT"}],"standard_charges":[{"minimum":1361.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1361.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1361.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1361.81,"methodology":"fee schedule"}]}]},{"description":"PANCREATORRHAPHY","code_information":[{"code":"48545","type":"CPT"}],"standard_charges":[{"minimum":1404.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404.72,"methodology":"fee schedule"}]}]},{"description":"DUODENAL EXCLUSION","code_information":[{"code":"48547","type":"CPT"}],"standard_charges":[{"minimum":1864.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1864.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1864.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1864.26,"methodology":"fee schedule"}]}]},{"description":"FUSE PANCREAS AND BOWEL","code_information":[{"code":"48548","type":"CPT"}],"standard_charges":[{"minimum":1740.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1740.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1740.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1740.52,"methodology":"fee schedule"}]}]},{"description":"DONOR PANCREATECTOMY","code_information":[{"code":"48550","type":"CPT"}],"standard_charges":[{"minimum":4573.57,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR PANCREAS","code_information":[{"code":"48551","type":"CPT"}],"standard_charges":[{"minimum":244.73,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.73,"methodology":"fee schedule"}]}]},{"description":"PREP DONOR PANCREAS/VENOUS","code_information":[{"code":"48552","type":"CPT"}],"standard_charges":[{"minimum":242.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"}]}]},{"description":"TRANSPL ALLOGRAFT PANCREAS","code_information":[{"code":"48554","type":"CPT"}],"standard_charges":[{"minimum":2750.43,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2750.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2750.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2750.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL ALLOGRAFT PANCREAS","code_information":[{"code":"48556","type":"CPT"}],"standard_charges":[{"minimum":1350.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"}]}]},{"description":"PANCREAS SURGERY PROCEDURE","code_information":[{"code":"48999","type":"CPT"}],"standard_charges":[{"minimum":462.2,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF ABDOMEN","code_information":[{"code":"49000","type":"CPT"}],"standard_charges":[{"minimum":803.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.92,"methodology":"fee schedule"}]}]},{"description":"REOPENING OF ABDOMEN","code_information":[{"code":"49002","type":"CPT"}],"standard_charges":[{"minimum":1086.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1086.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1086.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1086.8,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION BEHIND ABDOMEN","code_information":[{"code":"49010","type":"CPT"}],"standard_charges":[{"minimum":960.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.92,"methodology":"fee schedule"}]}]},{"description":"PRPERTL PEL PACK HEMRRG TRMA","code_information":[{"code":"49013","type":"CPT"}],"standard_charges":[{"minimum":470.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.98,"methodology":"fee schedule"}]}]},{"description":"REEXPLORATION PELVIC WOUND","code_information":[{"code":"49014","type":"CPT"}],"standard_charges":[{"minimum":392.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.31,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE ABDOM ABSCESS OPEN","code_information":[{"code":"49020","type":"CPT"}],"standard_charges":[{"minimum":1662.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1662.92,"methodology":"fee schedule"}]}]},{"description":"DRAIN OPEN ABDOM ABSCESS","code_information":[{"code":"49040","type":"CPT"}],"standard_charges":[{"minimum":1047.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.46,"methodology":"fee schedule"}]}]},{"description":"DRAIN OPEN RETROPERI ABSCESS","code_information":[{"code":"49060","type":"CPT"}],"standard_charges":[{"minimum":1142.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.59,"methodology":"fee schedule"}]}]},{"description":"DRAIN TO PERITONEAL CAVITY","code_information":[{"code":"49062","type":"CPT"}],"standard_charges":[{"minimum":805.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":805.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":805.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":805.35,"methodology":"fee schedule"}]}]},{"description":"ABD PARACENTESIS","code_information":[{"code":"49082","type":"CPT"}],"standard_charges":[{"minimum":76.17,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"ABD PARACENTESIS W/IMAGING","code_information":[{"code":"49083","type":"CPT"}],"standard_charges":[{"minimum":109.79,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"PERITONEAL LAVAGE","code_information":[{"code":"49084","type":"CPT"}],"standard_charges":[{"minimum":110.5,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"BIOPSY ABDOMINAL MASS","code_information":[{"code":"49180","type":"CPT"}],"standard_charges":[{"minimum":85.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"SCLEROTX FLUID COLLECTION","code_information":[{"code":"49185","type":"CPT"}],"standard_charges":[{"minimum":122.66,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXC ABD TUM 5 CM OR LESS","code_information":[{"code":"49203","type":"CPT"}],"standard_charges":[{"minimum":1248.8,"maximum":1248.8,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1248.8,"methodology":"fee schedule"}]}]},{"description":"EXC ABD TUM OVER 5 CM","code_information":[{"code":"49204","type":"CPT"}],"standard_charges":[{"minimum":1591.04,"maximum":1591.04,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1591.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1591.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1591.04,"methodology":"fee schedule"}]}]},{"description":"EXC ABD TUM OVER 10 CM","code_information":[{"code":"49205","type":"CPT"}],"standard_charges":[{"minimum":1824.92,"maximum":1824.92,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1824.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1824.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1824.92,"methodology":"fee schedule"}]}]},{"description":"EXCISE SACRAL SPINE TUMOR","code_information":[{"code":"49215","type":"CPT"}],"standard_charges":[{"minimum":2314.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2314.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2314.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2314.14,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF UMBILICUS","code_information":[{"code":"49250","type":"CPT"}],"standard_charges":[{"minimum":625.11,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":625.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":625.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":625.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF OMENTUM","code_information":[{"code":"49255","type":"CPT"}],"standard_charges":[{"minimum":832.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.17,"methodology":"fee schedule"}]}]},{"description":"DIAG LAPARO SEPARATE PROC","code_information":[{"code":"49320","type":"CPT"}],"standard_charges":[{"minimum":345.82,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY BIOPSY","code_information":[{"code":"49321","type":"CPT"}],"standard_charges":[{"minimum":361.91,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY ASPIRATION","code_information":[{"code":"49322","type":"CPT"}],"standard_charges":[{"minimum":393.38,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO DRAIN LYMPHOCELE","code_information":[{"code":"49323","type":"CPT"}],"standard_charges":[{"minimum":670.17,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAP INSERT TUNNEL IP CATH","code_information":[{"code":"49324","type":"CPT"}],"standard_charges":[{"minimum":404.11,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAP REVISION PERM IP CATH","code_information":[{"code":"49325","type":"CPT"}],"standard_charges":[{"minimum":430.93,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAP W/OMENTOPEXY ADD-ON","code_information":[{"code":"49326","type":"CPT"}],"standard_charges":[{"minimum":194.19,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.19,"methodology":"fee schedule"}]}]},{"description":"LAP INS DEVICE FOR RT","code_information":[{"code":"49327","type":"CPT"}],"standard_charges":[{"minimum":134.11,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"}]}]},{"description":"LAPARO PROC ABDM/PER/OMENT","code_information":[{"code":"49329","type":"CPT"}],"standard_charges":[{"minimum":2202,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"AIR INJECTION INTO ABDOMEN","code_information":[{"code":"49400","type":"CPT"}],"standard_charges":[{"minimum":92.98,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY ADBOMEN","code_information":[{"code":"49402","type":"CPT"}],"standard_charges":[{"minimum":893.33,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"IMAGE CATH FLUID COLXN VISC","code_information":[{"code":"49405","type":"CPT"}],"standard_charges":[{"minimum":199.55,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"IMAGE CATH FLUID PERI/RETRO","code_information":[{"code":"49406","type":"CPT"}],"standard_charges":[{"minimum":199.55,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"IMAGE CATH FLUID TRNS/VGNL","code_information":[{"code":"49407","type":"CPT"}],"standard_charges":[{"minimum":211.35,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"INS MARK ABD/PEL FOR RT PERQ","code_information":[{"code":"49411","type":"CPT"}],"standard_charges":[{"minimum":191.33,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1472.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1502.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1487.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1494.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"}]}]},{"description":"INS DEVICE FOR RT GUIDE OPEN","code_information":[{"code":"49412","type":"CPT"}],"standard_charges":[{"minimum":84.76,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.76,"methodology":"fee schedule"}]}]},{"description":"INSERT TUN IP CATH PERC","code_information":[{"code":"49418","type":"CPT"}],"standard_charges":[{"minimum":205.63,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"INSERT TUN IP CATH W/PORT","code_information":[{"code":"49419","type":"CPT"}],"standard_charges":[{"minimum":434.86,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5819.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5934.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5876.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5905.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5761.5,"methodology":"fee schedule"}]}]},{"description":"INS TUN IP CATH FOR DIAL OPN","code_information":[{"code":"49421","type":"CPT"}],"standard_charges":[{"minimum":233.88,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REMOVE TUNNELED IP CATH","code_information":[{"code":"49422","type":"CPT"}],"standard_charges":[{"minimum":228.87,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"EXCHANGE DRAINAGE CATHETER","code_information":[{"code":"49423","type":"CPT"}],"standard_charges":[{"minimum":72.6,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"ASSESS CYST CONTRAST INJECT","code_information":[{"code":"49424","type":"CPT"}],"standard_charges":[{"minimum":38.27,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"}]}]},{"description":"INSERT ABDOMEN-VENOUS DRAIN","code_information":[{"code":"49425","type":"CPT"}],"standard_charges":[{"minimum":818.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"}]}]},{"description":"REVISE ABDOMEN-VENOUS SHUNT","code_information":[{"code":"49426","type":"CPT"}],"standard_charges":[{"minimum":703.08,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"INJECTION ABDOMINAL SHUNT","code_information":[{"code":"49427","type":"CPT"}],"standard_charges":[{"minimum":40.05,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF SHUNT","code_information":[{"code":"49428","type":"CPT"}],"standard_charges":[{"minimum":450.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SHUNT","code_information":[{"code":"49429","type":"CPT"}],"standard_charges":[{"minimum":477.78,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3455.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3421.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3438.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3354.67,"methodology":"fee schedule"}]}]},{"description":"INSERT SUBQ EXTEN TO IP CATH","code_information":[{"code":"49435","type":"CPT"}],"standard_charges":[{"minimum":121.23,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"}]}]},{"description":"EMBEDDED IP CATH EXIT-SITE","code_information":[{"code":"49436","type":"CPT"}],"standard_charges":[{"minimum":194.9,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"PLACE GASTROSTOMY TUBE PERC","code_information":[{"code":"49440","type":"CPT"}],"standard_charges":[{"minimum":208.49,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"PLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"49441","type":"CPT"}],"standard_charges":[{"minimum":247.83,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"PLACE CECOSTOMY TUBE PERC","code_information":[{"code":"49442","type":"CPT"}],"standard_charges":[{"minimum":213.14,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1269.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1294.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1281.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1288.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1256.69,"methodology":"fee schedule"}]}]},{"description":"CHANGE G-TUBE TO G-J PERC","code_information":[{"code":"49446","type":"CPT"}],"standard_charges":[{"minimum":149.84,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2042.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2062.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2072.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2021.85,"methodology":"fee schedule"}]}]},{"description":"REPLACE G/C TUBE PERC","code_information":[{"code":"49450","type":"CPT"}],"standard_charges":[{"minimum":67.23,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"REPLACE DUOD/JEJ TUBE PERC","code_information":[{"code":"49451","type":"CPT"}],"standard_charges":[{"minimum":90.83,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"REPLACE G-J TUBE PERC","code_information":[{"code":"49452","type":"CPT"}],"standard_charges":[{"minimum":139.83,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"FIX G/COLON TUBE W/DEVICE","code_information":[{"code":"49460","type":"CPT"}],"standard_charges":[{"minimum":52.21,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"FLUORO EXAM OF G/COLON TUBE","code_information":[{"code":"49465","type":"CPT"}],"standard_charges":[{"minimum":31.47,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"RPR HERN PREEMIE REDUC","code_information":[{"code":"49491","type":"CPT"}],"standard_charges":[{"minimum":837.54,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"RPR ING HERN PREMIE BLOCKED","code_information":[{"code":"49492","type":"CPT"}],"standard_charges":[{"minimum":1005.26,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"RPR ING HERNIA BABY REDUC","code_information":[{"code":"49495","type":"CPT"}],"standard_charges":[{"minimum":430.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"RPR ING HERNIA BABY BLOCKED","code_information":[{"code":"49496","type":"CPT"}],"standard_charges":[{"minimum":647.64,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"RPR ING HERNIA INIT REDUCE","code_information":[{"code":"49500","type":"CPT"}],"standard_charges":[{"minimum":439.51,"maximum":6849.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6716.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6849.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6783.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6816.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"}]}]},{"description":"RPR ING HERNIA INIT BLOCKED","code_information":[{"code":"49501","type":"CPT"}],"standard_charges":[{"minimum":637.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"PRP I/HERN INIT REDUC >5 YR","code_information":[{"code":"49505","type":"CPT"}],"standard_charges":[{"minimum":550.01,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"PRP I/HERN INIT BLOCK >5 YR","code_information":[{"code":"49507","type":"CPT"}],"standard_charges":[{"minimum":617.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REREPAIR ING HERNIA REDUCE","code_information":[{"code":"49520","type":"CPT"}],"standard_charges":[{"minimum":665.53,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":665.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":665.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":665.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REREPAIR ING HERNIA BLOCKED","code_information":[{"code":"49521","type":"CPT"}],"standard_charges":[{"minimum":751.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6716.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6849.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6783.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6816.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"}]}]},{"description":"REPAIR ING HERNIA SLIDING","code_information":[{"code":"49525","type":"CPT"}],"standard_charges":[{"minimum":602.94,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR LUMBAR HERNIA","code_information":[{"code":"49540","type":"CPT"}],"standard_charges":[{"minimum":704.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"RPR REM HERNIA INIT REDUCE","code_information":[{"code":"49550","type":"CPT"}],"standard_charges":[{"minimum":607.23,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"RPR FEM HERNIA INIT BLOCKED","code_information":[{"code":"49553","type":"CPT"}],"standard_charges":[{"minimum":664.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REREPAIR FEM HERNIA REDUCE","code_information":[{"code":"49555","type":"CPT"}],"standard_charges":[{"minimum":635.49,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REREPAIR FEM HERNIA BLOCKED","code_information":[{"code":"49557","type":"CPT"}],"standard_charges":[{"minimum":757.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49600","type":"CPT"}],"standard_charges":[{"minimum":771.02,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49605","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5094.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5094.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5094.25,"methodology":"fee schedule"}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49606","type":"CPT"}],"standard_charges":[{"minimum":1184.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.79,"methodology":"fee schedule"}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49610","type":"CPT"}],"standard_charges":[{"minimum":728.47,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.47,"methodology":"fee schedule"}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49611","type":"CPT"}],"standard_charges":[{"minimum":642.64,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":642.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":642.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":642.64,"methodology":"fee schedule"}]}]},{"description":"LAP ING HERNIA REPAIR INIT","code_information":[{"code":"49650","type":"CPT"}],"standard_charges":[{"minimum":456.32,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAP ING HERNIA REPAIR RECUR","code_information":[{"code":"49651","type":"CPT"}],"standard_charges":[{"minimum":595.07,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO PROC HERNIA REPAIR","code_information":[{"code":"49659","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ABDOMINAL WALL","code_information":[{"code":"49900","type":"CPT"}],"standard_charges":[{"minimum":864.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.72,"methodology":"fee schedule"}]}]},{"description":"OMENTAL FLAP EXTRA-ABDOM","code_information":[{"code":"49904","type":"CPT"}],"standard_charges":[{"minimum":1452.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1452.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1452.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1452.28,"methodology":"fee schedule"}]}]},{"description":"OMENTAL FLAP INTRA-ABDOM","code_information":[{"code":"49905","type":"CPT"}],"standard_charges":[{"minimum":364.41,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"}]}]},{"description":"FREE OMENTAL FLAP MICROVASC","code_information":[{"code":"49906","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4017.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4017.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4017.33,"methodology":"fee schedule"}]}]},{"description":"ABDOMEN SURGERY PROCEDURE","code_information":[{"code":"49999","type":"CPT"}],"standard_charges":[{"minimum":601.63,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1009.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1029.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1019.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1024.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":999.27,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF KIDNEY","code_information":[{"code":"50010","type":"CPT"}],"standard_charges":[{"minimum":740.62,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"}]}]},{"description":"RENAL ABSCESS OPEN DRAIN","code_information":[{"code":"50020","type":"CPT"}],"standard_charges":[{"minimum":1062.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF KIDNEY","code_information":[{"code":"50040","type":"CPT"}],"standard_charges":[{"minimum":968.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.07,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF KIDNEY","code_information":[{"code":"50045","type":"CPT"}],"standard_charges":[{"minimum":975.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50060","type":"CPT"}],"standard_charges":[{"minimum":1189.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"}]}]},{"description":"INCISION OF KIDNEY","code_information":[{"code":"50065","type":"CPT"}],"standard_charges":[{"minimum":1259.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.53,"methodology":"fee schedule"}]}]},{"description":"INCISION OF KIDNEY","code_information":[{"code":"50070","type":"CPT"}],"standard_charges":[{"minimum":1235.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1235.57,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50075","type":"CPT"}],"standard_charges":[{"minimum":1518.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.08,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50080","type":"CPT"}],"standard_charges":[{"minimum":729.54,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50081","type":"CPT"}],"standard_charges":[{"minimum":1173.7,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"REVISE KIDNEY BLOOD VESSELS","code_information":[{"code":"50100","type":"CPT"}],"standard_charges":[{"minimum":1130.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.78,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF KIDNEY","code_information":[{"code":"50120","type":"CPT"}],"standard_charges":[{"minimum":992.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":992.74,"methodology":"fee schedule"}]}]},{"description":"EXPLORE AND DRAIN KIDNEY","code_information":[{"code":"50125","type":"CPT"}],"standard_charges":[{"minimum":1027.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1027.08,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50130","type":"CPT"}],"standard_charges":[{"minimum":1078.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.57,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF KIDNEY","code_information":[{"code":"50135","type":"CPT"}],"standard_charges":[{"minimum":1169.77,"maximum":1169.77,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.77,"methodology":"fee schedule"}]}]},{"description":"RENAL BIOPSY PERQ","code_information":[{"code":"50200","type":"CPT"}],"standard_charges":[{"minimum":130.89,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"RENAL BIOPSY OPEN","code_information":[{"code":"50205","type":"CPT"}],"standard_charges":[{"minimum":789.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.98,"methodology":"fee schedule"}]}]},{"description":"REMOVE KIDNEY OPEN","code_information":[{"code":"50220","type":"CPT"}],"standard_charges":[{"minimum":1099.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.31,"methodology":"fee schedule"}]}]},{"description":"REMOVAL KIDNEY OPEN COMPLEX","code_information":[{"code":"50225","type":"CPT"}],"standard_charges":[{"minimum":1263.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1263.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1263.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1263.46,"methodology":"fee schedule"}]}]},{"description":"REMOVAL KIDNEY OPEN RADICAL","code_information":[{"code":"50230","type":"CPT"}],"standard_charges":[{"minimum":1333.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1333.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1333.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1333.2,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY  URETER","code_information":[{"code":"50234","type":"CPT"}],"standard_charges":[{"minimum":1355.73,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1355.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1355.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1355.73,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY  URETER","code_information":[{"code":"50236","type":"CPT"}],"standard_charges":[{"minimum":1525.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.59,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF KIDNEY","code_information":[{"code":"50240","type":"CPT"}],"standard_charges":[{"minimum":1386.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.48,"methodology":"fee schedule"}]}]},{"description":"CRYOABLATE RENAL MASS OPEN","code_information":[{"code":"50250","type":"CPT"}],"standard_charges":[{"minimum":1269.54,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1269.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1269.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1269.54,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY LESION","code_information":[{"code":"50280","type":"CPT"}],"standard_charges":[{"minimum":989.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":989.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":989.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":989.17,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY LESION","code_information":[{"code":"50290","type":"CPT"}],"standard_charges":[{"minimum":940.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE CADAVER DONOR KIDNEY","code_information":[{"code":"50300","type":"CPT"}],"standard_charges":[{"minimum":701.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.49,"methodology":"fee schedule"}]}]},{"description":"REMOVE KIDNEY LIVING DONOR","code_information":[{"code":"50320","type":"CPT"}],"standard_charges":[{"minimum":1597.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1597.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1597.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1597.12,"methodology":"fee schedule"}]}]},{"description":"PREP CADAVER RENAL ALLOGRAFT","code_information":[{"code":"50323","type":"CPT"}],"standard_charges":[{"minimum":202.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"}]}]},{"description":"PREP DONOR RENAL GRAFT","code_information":[{"code":"50325","type":"CPT"}],"standard_charges":[{"minimum":202.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.66,"methodology":"fee schedule"}]}]},{"description":"PREP RENAL GRAFT/VENOUS","code_information":[{"code":"50327","type":"CPT"}],"standard_charges":[{"minimum":223.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.15,"methodology":"fee schedule"}]}]},{"description":"PREP RENAL GRAFT/ARTERIAL","code_information":[{"code":"50328","type":"CPT"}],"standard_charges":[{"minimum":195.62,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"}]}]},{"description":"PREP RENAL GRAFT/URETERAL","code_information":[{"code":"50329","type":"CPT"}],"standard_charges":[{"minimum":185.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF KIDNEY","code_information":[{"code":"50340","type":"CPT"}],"standard_charges":[{"minimum":1008.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANTATION OF KIDNEY","code_information":[{"code":"50360","type":"CPT"}],"standard_charges":[{"minimum":2541.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2541.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2541.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2541.94,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANTATION OF KIDNEY","code_information":[{"code":"50365","type":"CPT"}],"standard_charges":[{"minimum":3035.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3035.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3035.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3035.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE TRANSPLANTED KIDNEY","code_information":[{"code":"50370","type":"CPT"}],"standard_charges":[{"minimum":1275.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.26,"methodology":"fee schedule"}]}]},{"description":"REIMPLANTATION OF KIDNEY","code_information":[{"code":"50380","type":"CPT"}],"standard_charges":[{"minimum":2138.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2138.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2138.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2138.91,"methodology":"fee schedule"}]}]},{"description":"CHANGE URETER STENT PERCUT","code_information":[{"code":"50382","type":"CPT"}],"standard_charges":[{"minimum":257.48,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVE URETER STENT PERCUT","code_information":[{"code":"50384","type":"CPT"}],"standard_charges":[{"minimum":232.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CHANGE STENT VIA TRANSURETH","code_information":[{"code":"50385","type":"CPT"}],"standard_charges":[{"minimum":221.72,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVE STENT VIA TRANSURETH","code_information":[{"code":"50386","type":"CPT"}],"standard_charges":[{"minimum":168.08,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CHANGE NEPHROURETERAL CATH","code_information":[{"code":"50387","type":"CPT"}],"standard_charges":[{"minimum":85.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVE RENAL TUBE W/FLUORO","code_information":[{"code":"50389","type":"CPT"}],"standard_charges":[{"minimum":54.72,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF KIDNEY LESION","code_information":[{"code":"50390","type":"CPT"}],"standard_charges":[{"minimum":97.27,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"INSTLL RX AGNT INTO RNAL TUB","code_information":[{"code":"50391","type":"CPT"}],"standard_charges":[{"minimum":101.92,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"MEASURE KIDNEY PRESSURE","code_information":[{"code":"50396","type":"CPT"}],"standard_charges":[{"minimum":119.8,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"REVISION OF KIDNEY/URETER","code_information":[{"code":"50400","type":"CPT"}],"standard_charges":[{"minimum":1205.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1205.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1205.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1205.53,"methodology":"fee schedule"}]}]},{"description":"REVISION OF KIDNEY/URETER","code_information":[{"code":"50405","type":"CPT"}],"standard_charges":[{"minimum":1454.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1454.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1454.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1454.07,"methodology":"fee schedule"}]}]},{"description":"NJX PX NFROSGRM /URTRGRM","code_information":[{"code":"50430","type":"CPT"}],"standard_charges":[{"minimum":158.07,"maximum":2595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":744.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":558.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":558.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"NJX PX NFROSGRM /URTRGRM","code_information":[{"code":"50431","type":"CPT"}],"standard_charges":[{"minimum":68.3,"maximum":2595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":222.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":222.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"PLMT NEPHROSTOMY CATHETER","code_information":[{"code":"50432","type":"CPT"}],"standard_charges":[{"minimum":209.56,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"PLMT NEPHROURETERAL CATHETER","code_information":[{"code":"50433","type":"CPT"}],"standard_charges":[{"minimum":260.35,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1213.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":910.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":910.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CONVERT NEPHROSTOMY CATHETER","code_information":[{"code":"50434","type":"CPT"}],"standard_charges":[{"minimum":195.62,"maximum":2595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":930.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":697.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":697.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"EXCHANGE NEPHROSTOMY CATH","code_information":[{"code":"50435","type":"CPT"}],"standard_charges":[{"minimum":102.64,"maximum":2595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"DILAT XST TRC NDURLGC PX","code_information":[{"code":"50436","type":"CPT"}],"standard_charges":[{"minimum":153.78,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"DILAT XST TRC NEW ACCESS RCS","code_information":[{"code":"50437","type":"CPT"}],"standard_charges":[{"minimum":254.98,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF KIDNEY WOUND","code_information":[{"code":"50500","type":"CPT"}],"standard_charges":[{"minimum":1344.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.28,"methodology":"fee schedule"}]}]},{"description":"CLOSE KIDNEY-SKIN FISTULA","code_information":[{"code":"50520","type":"CPT"}],"standard_charges":[{"minimum":1211.61,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1211.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1211.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1211.61,"methodology":"fee schedule"}]}]},{"description":"CLOSE NEPHROVISCERAL FISTULA","code_information":[{"code":"50525","type":"CPT"}],"standard_charges":[{"minimum":1534.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1534.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1534.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1534.53,"methodology":"fee schedule"}]}]},{"description":"CLOSE NEPHROVISCERAL FISTULA","code_information":[{"code":"50526","type":"CPT"}],"standard_charges":[{"minimum":1642.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1642.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1642.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1642.53,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HORSESHOE KIDNEY","code_information":[{"code":"50540","type":"CPT"}],"standard_charges":[{"minimum":1196.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1196.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1196.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1196.59,"methodology":"fee schedule"}]}]},{"description":"LAPARO ABLATE RENAL CYST","code_information":[{"code":"50541","type":"CPT"}],"standard_charges":[{"minimum":957.34,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO ABLATE RENAL MASS","code_information":[{"code":"50542","type":"CPT"}],"standard_charges":[{"minimum":1211.25,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1211.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1211.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1211.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO PARTIAL NEPHRECTOMY","code_information":[{"code":"50543","type":"CPT"}],"standard_charges":[{"minimum":1553.49,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1553.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1553.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1553.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY PYELOPLASTY","code_information":[{"code":"50544","type":"CPT"}],"standard_charges":[{"minimum":1292.07,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO RADICAL NEPHRECTOMY","code_information":[{"code":"50545","type":"CPT"}],"standard_charges":[{"minimum":1390.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1390.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1390.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1390.06,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPIC NEPHRECTOMY","code_information":[{"code":"50546","type":"CPT"}],"standard_charges":[{"minimum":1255.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1255.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1255.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1255.59,"methodology":"fee schedule"}]}]},{"description":"LAPARO REMOVAL DONOR KIDNEY","code_information":[{"code":"50547","type":"CPT"}],"standard_charges":[{"minimum":1695.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1695.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1695.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1695.1,"methodology":"fee schedule"}]}]},{"description":"LAPARO REMOVE W/URETER","code_information":[{"code":"50548","type":"CPT"}],"standard_charges":[{"minimum":1397.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.57,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC RENAL","code_information":[{"code":"50549","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50551","type":"CPT"}],"standard_charges":[{"minimum":303.97,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50553","type":"CPT"}],"standard_charges":[{"minimum":325.07,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY  BIOPSY","code_information":[{"code":"50555","type":"CPT"}],"standard_charges":[{"minimum":352.97,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY  TREATMENT","code_information":[{"code":"50557","type":"CPT"}],"standard_charges":[{"minimum":357.26,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY  TREATMENT","code_information":[{"code":"50561","type":"CPT"}],"standard_charges":[{"minimum":408.4,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RENAL SCOPE W/TUMOR RESECT","code_information":[{"code":"50562","type":"CPT"}],"standard_charges":[{"minimum":599.37,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50570","type":"CPT"}],"standard_charges":[{"minimum":507.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50572","type":"CPT"}],"standard_charges":[{"minimum":548.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY  BIOPSY","code_information":[{"code":"50574","type":"CPT"}],"standard_charges":[{"minimum":583.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50575","type":"CPT"}],"standard_charges":[{"minimum":736.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY  TREATMENT","code_information":[{"code":"50576","type":"CPT"}],"standard_charges":[{"minimum":581.49,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"KIDNEY ENDOSCOPY  TREATMENT","code_information":[{"code":"50580","type":"CPT"}],"standard_charges":[{"minimum":626.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"FRAGMENTING OF KIDNEY STONE","code_information":[{"code":"50590","type":"CPT"}],"standard_charges":[{"minimum":601.51,"maximum":13388.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13388.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10042.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10042.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"PERC RF ABLATE RENAL TUMOR","code_information":[{"code":"50592","type":"CPT"}],"standard_charges":[{"minimum":352.97,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PERC CRYO ABLATE RENAL TUM","code_information":[{"code":"50593","type":"CPT"}],"standard_charges":[{"minimum":470.98,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF URETER","code_information":[{"code":"50600","type":"CPT"}],"standard_charges":[{"minimum":979.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.51,"methodology":"fee schedule"}]}]},{"description":"INSERT URETERAL SUPPORT","code_information":[{"code":"50605","type":"CPT"}],"standard_charges":[{"minimum":1052.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.11,"methodology":"fee schedule"}]}]},{"description":"ENDOLUMINAL BX URTR RNL PLVS","code_information":[{"code":"50606","type":"CPT"}],"standard_charges":[{"minimum":142.69,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETER STONE","code_information":[{"code":"50610","type":"CPT"}],"standard_charges":[{"minimum":986.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.31,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETER STONE","code_information":[{"code":"50620","type":"CPT"}],"standard_charges":[{"minimum":944.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":944.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":944.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":944.11,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETER STONE","code_information":[{"code":"50630","type":"CPT"}],"standard_charges":[{"minimum":933.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.02,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETER","code_information":[{"code":"50650","type":"CPT"}],"standard_charges":[{"minimum":1085.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1085.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1085.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1085.37,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETER","code_information":[{"code":"50660","type":"CPT"}],"standard_charges":[{"minimum":1192.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192.65,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR URETER X-RAY","code_information":[{"code":"50684","type":"CPT"}],"standard_charges":[{"minimum":53.28,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":161.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":161.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"}]}]},{"description":"MEASURE URETER PRESSURE","code_information":[{"code":"50686","type":"CPT"}],"standard_charges":[{"minimum":92.62,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"CHANGE OF URETER TUBE/STENT","code_information":[{"code":"50688","type":"CPT"}],"standard_charges":[{"minimum":81.18,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR URETER X-RAY","code_information":[{"code":"50690","type":"CPT"}],"standard_charges":[{"minimum":72.6,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":228.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":228.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"}]}]},{"description":"PLMT URETERAL STENT PRQ","code_information":[{"code":"50693","type":"CPT"}],"standard_charges":[{"minimum":208.49,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"PLMT URETERAL STENT PRQ","code_information":[{"code":"50694","type":"CPT"}],"standard_charges":[{"minimum":272.15,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"PLMT URETERAL STENT PRQ","code_information":[{"code":"50695","type":"CPT"}],"standard_charges":[{"minimum":349.39,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISION OF URETER","code_information":[{"code":"50700","type":"CPT"}],"standard_charges":[{"minimum":968.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.78,"methodology":"fee schedule"}]}]},{"description":"URETERAL EMBOLIZATION/OCCL","code_information":[{"code":"50705","type":"CPT"}],"standard_charges":[{"minimum":181.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"}]}]},{"description":"BALLOON DILATE URTRL STRIX","code_information":[{"code":"50706","type":"CPT"}],"standard_charges":[{"minimum":184.89,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.89,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF URETER","code_information":[{"code":"50715","type":"CPT"}],"standard_charges":[{"minimum":1263.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1263.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1263.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1263.1,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF URETER","code_information":[{"code":"50722","type":"CPT"}],"standard_charges":[{"minimum":1071.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.06,"methodology":"fee schedule"}]}]},{"description":"RELEASE/REVISE URETER","code_information":[{"code":"50725","type":"CPT"}],"standard_charges":[{"minimum":1150.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.1,"methodology":"fee schedule"}]}]},{"description":"REVISE URETER","code_information":[{"code":"50727","type":"CPT"}],"standard_charges":[{"minimum":539.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISE URETER","code_information":[{"code":"50728","type":"CPT"}],"standard_charges":[{"minimum":735.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.26,"methodology":"fee schedule"}]}]},{"description":"FUSION OF URETER  KIDNEY","code_information":[{"code":"50740","type":"CPT"}],"standard_charges":[{"minimum":1279.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.55,"methodology":"fee schedule"}]}]},{"description":"FUSION OF URETER  KIDNEY","code_information":[{"code":"50750","type":"CPT"}],"standard_charges":[{"minimum":1203.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"}]}]},{"description":"FUSION OF URETERS","code_information":[{"code":"50760","type":"CPT"}],"standard_charges":[{"minimum":1179.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.78,"methodology":"fee schedule"}]}]},{"description":"SPLICING OF URETERS","code_information":[{"code":"50770","type":"CPT"}],"standard_charges":[{"minimum":1203.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"}]}]},{"description":"REIMPLANT URETER IN BLADDER","code_information":[{"code":"50780","type":"CPT"}],"standard_charges":[{"minimum":1161.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1161.9,"methodology":"fee schedule"}]}]},{"description":"REIMPLANT URETER IN BLADDER","code_information":[{"code":"50782","type":"CPT"}],"standard_charges":[{"minimum":1121.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1121.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1121.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1121.84,"methodology":"fee schedule"}]}]},{"description":"REIMPLANT URETER IN BLADDER","code_information":[{"code":"50783","type":"CPT"}],"standard_charges":[{"minimum":1175.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.84,"methodology":"fee schedule"}]}]},{"description":"REIMPLANT URETER IN BLADDER","code_information":[{"code":"50785","type":"CPT"}],"standard_charges":[{"minimum":1264.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.89,"methodology":"fee schedule"}]}]},{"description":"IMPLANT URETER IN BOWEL","code_information":[{"code":"50800","type":"CPT"}],"standard_charges":[{"minimum":965.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.21,"methodology":"fee schedule"}]}]},{"description":"FUSION OF URETER  BOWEL","code_information":[{"code":"50810","type":"CPT"}],"standard_charges":[{"minimum":1469.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1469.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1469.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1469.09,"methodology":"fee schedule"}]}]},{"description":"URINE SHUNT TO INTESTINE","code_information":[{"code":"50815","type":"CPT"}],"standard_charges":[{"minimum":1278.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.84,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCT BOWEL BLADDER","code_information":[{"code":"50820","type":"CPT"}],"standard_charges":[{"minimum":1368.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1368.96,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCT BOWEL BLADDER","code_information":[{"code":"50825","type":"CPT"}],"standard_charges":[{"minimum":1714.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.42,"methodology":"fee schedule"}]}]},{"description":"REVISE URINE FLOW","code_information":[{"code":"50830","type":"CPT"}],"standard_charges":[{"minimum":1874.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1874.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1874.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1874.27,"methodology":"fee schedule"}]}]},{"description":"REPLACE URETER BY BOWEL","code_information":[{"code":"50840","type":"CPT"}],"standard_charges":[{"minimum":1285.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285.28,"methodology":"fee schedule"}]}]},{"description":"APPENDICO-VESICOSTOMY","code_information":[{"code":"50845","type":"CPT"}],"standard_charges":[{"minimum":1311.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.38,"methodology":"fee schedule"}]}]},{"description":"TRANSPLANT URETER TO SKIN","code_information":[{"code":"50860","type":"CPT"}],"standard_charges":[{"minimum":988.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.81,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETER","code_information":[{"code":"50900","type":"CPT"}],"standard_charges":[{"minimum":882.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.96,"methodology":"fee schedule"}]}]},{"description":"CLOSURE URETER/SKIN FISTULA","code_information":[{"code":"50920","type":"CPT"}],"standard_charges":[{"minimum":923.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.01,"methodology":"fee schedule"}]}]},{"description":"CLOSURE URETER/BOWEL FISTULA","code_information":[{"code":"50930","type":"CPT"}],"standard_charges":[{"minimum":1149.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF URETER","code_information":[{"code":"50940","type":"CPT"}],"standard_charges":[{"minimum":928.73,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.73,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY URETEROLITHOTOMY","code_information":[{"code":"50945","type":"CPT"}],"standard_charges":[{"minimum":1012.41,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO NEW URETER/BLADDER","code_information":[{"code":"50947","type":"CPT"}],"standard_charges":[{"minimum":1442.27,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1442.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1442.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1442.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO NEW URETER/BLADDER","code_information":[{"code":"50948","type":"CPT"}],"standard_charges":[{"minimum":1322.83,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1322.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1322.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1322.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC URETER","code_information":[{"code":"50949","type":"CPT"}],"standard_charges":[{"minimum":3295.22,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY OF URETER","code_information":[{"code":"50951","type":"CPT"}],"standard_charges":[{"minimum":317.56,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY OF URETER","code_information":[{"code":"50953","type":"CPT"}],"standard_charges":[{"minimum":337.59,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"URETER ENDOSCOPY  BIOPSY","code_information":[{"code":"50955","type":"CPT"}],"standard_charges":[{"minimum":364.41,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"URETER ENDOSCOPY  TREATMENT","code_information":[{"code":"50957","type":"CPT"}],"standard_charges":[{"minimum":366.2,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"URETER ENDOSCOPY  TREATMENT","code_information":[{"code":"50961","type":"CPT"}],"standard_charges":[{"minimum":328.29,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"URETER ENDOSCOPY","code_information":[{"code":"50970","type":"CPT"}],"standard_charges":[{"minimum":383.01,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"URETER ENDOSCOPY  CATHETER","code_information":[{"code":"50972","type":"CPT"}],"standard_charges":[{"minimum":369.78,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"URETER ENDOSCOPY  BIOPSY","code_information":[{"code":"50974","type":"CPT"}],"standard_charges":[{"minimum":488.5,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":488.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":488.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":488.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"URETER ENDOSCOPY  TREATMENT","code_information":[{"code":"50976","type":"CPT"}],"standard_charges":[{"minimum":482.07,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"URETER ENDOSCOPY  TREATMENT","code_information":[{"code":"50980","type":"CPT"}],"standard_charges":[{"minimum":367.99,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":367.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"INCISE  TREAT BLADDER","code_information":[{"code":"51020","type":"CPT"}],"standard_charges":[{"minimum":496.37,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"INCISE  TREAT BLADDER","code_information":[{"code":"51030","type":"CPT"}],"standard_charges":[{"minimum":499.95,"maximum":6060,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6060,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6060,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"}]}]},{"description":"INCISE  DRAIN BLADDER","code_information":[{"code":"51040","type":"CPT"}],"standard_charges":[{"minimum":308.62,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"INCISE BLADDER/DRAIN URETER","code_information":[{"code":"51045","type":"CPT"}],"standard_charges":[{"minimum":523.55,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BLADDER STONE","code_information":[{"code":"51050","type":"CPT"}],"standard_charges":[{"minimum":497.45,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETER STONE","code_information":[{"code":"51060","type":"CPT"}],"standard_charges":[{"minimum":613.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVE URETER CALCULUS","code_information":[{"code":"51065","type":"CPT"}],"standard_charges":[{"minimum":610.81,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF BLADDER ABSCESS","code_information":[{"code":"51080","type":"CPT"}],"standard_charges":[{"minimum":431.64,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DRAIN BLADDER BY NEEDLE","code_information":[{"code":"51100","type":"CPT"}],"standard_charges":[{"minimum":40.77,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"DRAIN BLADDER BY TROCAR/CATH","code_information":[{"code":"51101","type":"CPT"}],"standard_charges":[{"minimum":52.93,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1084.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1095.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1116.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1106.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1084.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1084.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1084.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1111.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1084.35,"methodology":"fee schedule"}]}]},{"description":"DRAIN BL W/CATH INSERTION","code_information":[{"code":"51102","type":"CPT"}],"standard_charges":[{"minimum":148.05,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BLADDER CYST","code_information":[{"code":"51500","type":"CPT"}],"standard_charges":[{"minimum":669.82,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BLADDER LESION","code_information":[{"code":"51520","type":"CPT"}],"standard_charges":[{"minimum":626.54,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BLADDER LESION","code_information":[{"code":"51525","type":"CPT"}],"standard_charges":[{"minimum":897.26,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.26,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BLADDER LESION","code_information":[{"code":"51530","type":"CPT"}],"standard_charges":[{"minimum":807.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.14,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETER LESION","code_information":[{"code":"51535","type":"CPT"}],"standard_charges":[{"minimum":816.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF BLADDER","code_information":[{"code":"51550","type":"CPT"}],"standard_charges":[{"minimum":1007.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.41,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF BLADDER","code_information":[{"code":"51555","type":"CPT"}],"standard_charges":[{"minimum":1315.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1315.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1315.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1315.67,"methodology":"fee schedule"}]}]},{"description":"REVISE BLADDER  URETER(S)","code_information":[{"code":"51565","type":"CPT"}],"standard_charges":[{"minimum":1343.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1343.92,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BLADDER","code_information":[{"code":"51570","type":"CPT"}],"standard_charges":[{"minimum":1533.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BLADDER  NODES","code_information":[{"code":"51575","type":"CPT"}],"standard_charges":[{"minimum":1888.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1888.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1888.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1888.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE BLADDER/REVISE TRACT","code_information":[{"code":"51580","type":"CPT"}],"standard_charges":[{"minimum":1973.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1973.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1973.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1973.33,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BLADDER  NODES","code_information":[{"code":"51585","type":"CPT"}],"standard_charges":[{"minimum":2193.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2193.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2193.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2193.27,"methodology":"fee schedule"}]}]},{"description":"REMOVE BLADDER/REVISE TRACT","code_information":[{"code":"51590","type":"CPT"}],"standard_charges":[{"minimum":2006.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.59,"methodology":"fee schedule"}]}]},{"description":"REMOVE BLADDER/REVISE TRACT","code_information":[{"code":"51595","type":"CPT"}],"standard_charges":[{"minimum":2271.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2271.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2271.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2271.58,"methodology":"fee schedule"}]}]},{"description":"REMOVE BLADDER/CREATE POUCH","code_information":[{"code":"51596","type":"CPT"}],"standard_charges":[{"minimum":2447.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2447.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2447.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2447.89,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PELVIC STRUCTURES","code_information":[{"code":"51597","type":"CPT"}],"standard_charges":[{"minimum":2390.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2390.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2390.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2390.31,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR BLADDER X-RAY","code_information":[{"code":"51600","type":"CPT"}],"standard_charges":[{"minimum":45.06,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":146.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":146.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"}]}]},{"description":"PREPARATION FOR BLADDER XRAY","code_information":[{"code":"51605","type":"CPT"}],"standard_charges":[{"minimum":40.41,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR BLADDER X-RAY","code_information":[{"code":"51610","type":"CPT"}],"standard_charges":[{"minimum":66.87,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"}]}]},{"description":"IRRIGATION OF BLADDER","code_information":[{"code":"51700","type":"CPT"}],"standard_charges":[{"minimum":31.11,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"INSERT BLADDER CATHETER","code_information":[{"code":"51701","type":"CPT"}],"standard_charges":[{"minimum":26.82,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"INSERT TEMP BLADDER CATH","code_information":[{"code":"51702","type":"CPT"}],"standard_charges":[{"minimum":26.46,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"INSERT BLADDER CATH COMPLEX","code_information":[{"code":"51703","type":"CPT"}],"standard_charges":[{"minimum":79.39,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"CHANGE OF BLADDER TUBE","code_information":[{"code":"51705","type":"CPT"}],"standard_charges":[{"minimum":54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"CHANGE OF BLADDER TUBE","code_information":[{"code":"51710","type":"CPT"}],"standard_charges":[{"minimum":83.68,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPIC INJECTION/IMPLANT","code_information":[{"code":"51715","type":"CPT"}],"standard_charges":[{"minimum":207.42,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF BLADDER LESION","code_information":[{"code":"51720","type":"CPT"}],"standard_charges":[{"minimum":45.42,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":45.8,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":45.8,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"SIMPLE CYSTOMETROGRAM","code_information":[{"code":"51725","type":"CPT"}],"standard_charges":[{"minimum":238.89,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"COMPLEX CYSTOMETROGRAM","code_information":[{"code":"51726","type":"CPT"}],"standard_charges":[{"minimum":259.22,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOMETROGRAM W/UP","code_information":[{"code":"51727","type":"CPT"}],"standard_charges":[{"minimum":383.72,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"CYSTOMETROGRAM W/VP","code_information":[{"code":"51728","type":"CPT"}],"standard_charges":[{"minimum":381.22,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"CYSTOMETROGRAM W/VPUP","code_information":[{"code":"51729","type":"CPT"}],"standard_charges":[{"minimum":402.32,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"URINE FLOW MEASUREMENT","code_information":[{"code":"51736","type":"CPT"}],"standard_charges":[{"minimum":14.3,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"ELECTRO-UROFLOWMETRY FIRST","code_information":[{"code":"51741","type":"CPT"}],"standard_charges":[{"minimum":15.02,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":341.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":338.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"}]}]},{"description":"ANAL/URINARY MUSCLE STUDY","code_information":[{"code":"51784","type":"CPT"}],"standard_charges":[{"minimum":67.59,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"ANAL/URINARY MUSCLE STUDY","code_information":[{"code":"51785","type":"CPT"}],"standard_charges":[{"minimum":259.22,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"URINARY REFLEX STUDY","code_information":[{"code":"51792","type":"CPT"}],"standard_charges":[{"minimum":63.31,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"INTRAABDOMINAL PRESSURE TEST","code_information":[{"code":"51797","type":"CPT"}],"standard_charges":[{"minimum":198.12,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":281.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":281.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.12,"methodology":"fee schedule"}]}]},{"description":"US URINE CAPACITY MEASURE","code_information":[{"code":"51798","type":"CPT"}],"standard_charges":[{"minimum":11.8,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"REVISION OF BLADDER/URETHRA","code_information":[{"code":"51800","type":"CPT"}],"standard_charges":[{"minimum":1084.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.29,"methodology":"fee schedule"}]}]},{"description":"REVISION OF URINARY TRACT","code_information":[{"code":"51820","type":"CPT"}],"standard_charges":[{"minimum":1133.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1133.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1133.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1133.65,"methodology":"fee schedule"}]}]},{"description":"ATTACH BLADDER/URETHRA","code_information":[{"code":"51840","type":"CPT"}],"standard_charges":[{"minimum":731.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.33,"methodology":"fee schedule"}]}]},{"description":"ATTACH BLADDER/URETHRA","code_information":[{"code":"51841","type":"CPT"}],"standard_charges":[{"minimum":845.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLADDER NECK","code_information":[{"code":"51845","type":"CPT"}],"standard_charges":[{"minimum":612.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF BLADDER WOUND","code_information":[{"code":"51860","type":"CPT"}],"standard_charges":[{"minimum":781.75,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF BLADDER WOUND","code_information":[{"code":"51865","type":"CPT"}],"standard_charges":[{"minimum":937.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":937.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":937.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":937.31,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF BLADDER OPENING","code_information":[{"code":"51880","type":"CPT"}],"standard_charges":[{"minimum":490.65,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLADDER/VAGINA LESION","code_information":[{"code":"51900","type":"CPT"}],"standard_charges":[{"minimum":863.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":863.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":863.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":863.65,"methodology":"fee schedule"}]}]},{"description":"CLOSE BLADDER-UTERUS FISTULA","code_information":[{"code":"51920","type":"CPT"}],"standard_charges":[{"minimum":800.7,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.7,"methodology":"fee schedule"}]}]},{"description":"HYSTERECTOMY/BLADDER REPAIR","code_information":[{"code":"51925","type":"CPT"}],"standard_charges":[{"minimum":1133.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1133.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1133.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1133.29,"methodology":"fee schedule"}]}]},{"description":"CORRECTION OF BLADDER DEFECT","code_information":[{"code":"51940","type":"CPT"}],"standard_charges":[{"minimum":1707.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1707.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1707.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1707.98,"methodology":"fee schedule"}]}]},{"description":"REVISION OF BLADDER  BOWEL","code_information":[{"code":"51960","type":"CPT"}],"standard_charges":[{"minimum":1444.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1444.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1444.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1444.06,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCT BLADDER OPENING","code_information":[{"code":"51980","type":"CPT"}],"standard_charges":[{"minimum":748.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.85,"methodology":"fee schedule"}]}]},{"description":"LAPARO URETHRAL SUSPENSION","code_information":[{"code":"51990","type":"CPT"}],"standard_charges":[{"minimum":779.61,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO SLING OPERATION","code_information":[{"code":"51992","type":"CPT"}],"standard_charges":[{"minimum":876.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC BLA","code_information":[{"code":"51999","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY","code_information":[{"code":"52000","type":"CPT"}],"standard_charges":[{"minimum":83.68,"maximum":12318,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY REMOVAL OF CLOTS","code_information":[{"code":"52001","type":"CPT"}],"standard_charges":[{"minimum":297.18,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY  URETER CATHETER","code_information":[{"code":"52005","type":"CPT"}],"standard_charges":[{"minimum":138.76,"maximum":12318,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND BIOPSY","code_information":[{"code":"52007","type":"CPT"}],"standard_charges":[{"minimum":172.73,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY  DUCT CATHETER","code_information":[{"code":"52010","type":"CPT"}],"standard_charges":[{"minimum":171.66,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY W/BIOPSY(S)","code_information":[{"code":"52204","type":"CPT"}],"standard_charges":[{"minimum":146.98,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52214","type":"CPT"}],"standard_charges":[{"minimum":180.95,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52224","type":"CPT"}],"standard_charges":[{"minimum":209.21,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52234","type":"CPT"}],"standard_charges":[{"minimum":254.62,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52235","type":"CPT"}],"standard_charges":[{"minimum":298.61,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52240","type":"CPT"}],"standard_charges":[{"minimum":405.54,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND RADIOTRACER","code_information":[{"code":"52250","type":"CPT"}],"standard_charges":[{"minimum":247.47,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52260","type":"CPT"}],"standard_charges":[{"minimum":218.15,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52265","type":"CPT"}],"standard_charges":[{"minimum":168.44,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY  REVISE URETHRA","code_information":[{"code":"52270","type":"CPT"}],"standard_charges":[{"minimum":188.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY  REVISE URETHRA","code_information":[{"code":"52275","type":"CPT"}],"standard_charges":[{"minimum":257.13,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52276","type":"CPT"}],"standard_charges":[{"minimum":273.58,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52277","type":"CPT"}],"standard_charges":[{"minimum":334.37,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52281","type":"CPT"}],"standard_charges":[{"minimum":158.07,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY IMPLANT STENT","code_information":[{"code":"52282","type":"CPT"}],"standard_charges":[{"minimum":348.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52283","type":"CPT"}],"standard_charges":[{"minimum":208.85,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52285","type":"CPT"}],"standard_charges":[{"minimum":203.48,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY CHEMODENERVATION","code_information":[{"code":"52287","type":"CPT"}],"standard_charges":[{"minimum":175.23,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52290","type":"CPT"}],"standard_charges":[{"minimum":252.12,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52300","type":"CPT"}],"standard_charges":[{"minimum":289.67,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52301","type":"CPT"}],"standard_charges":[{"minimum":300.04,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52305","type":"CPT"}],"standard_charges":[{"minimum":287.52,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52310","type":"CPT"}],"standard_charges":[{"minimum":157.35,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52315","type":"CPT"}],"standard_charges":[{"minimum":283.95,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVE BLADDER STONE","code_information":[{"code":"52317","type":"CPT"}],"standard_charges":[{"minimum":357.97,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVE BLADDER STONE","code_information":[{"code":"52318","type":"CPT"}],"standard_charges":[{"minimum":489.22,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52320","type":"CPT"}],"standard_charges":[{"minimum":254.62,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY STONE REMOVAL","code_information":[{"code":"52325","type":"CPT"}],"standard_charges":[{"minimum":330.8,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY INJECT MATERIAL","code_information":[{"code":"52327","type":"CPT"}],"standard_charges":[{"minimum":267.5,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52330","type":"CPT"}],"standard_charges":[{"minimum":272.5,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52332","type":"CPT"}],"standard_charges":[{"minimum":161.29,"maximum":12318,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CREATE PASSAGE TO KIDNEY","code_information":[{"code":"52334","type":"CPT"}],"standard_charges":[{"minimum":189.18,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTO W/URETER STRICTURE TX","code_information":[{"code":"52341","type":"CPT"}],"standard_charges":[{"minimum":293.96,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTO W/UP STRICTURE TX","code_information":[{"code":"52342","type":"CPT"}],"standard_charges":[{"minimum":320.07,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTO W/RENAL STRICTURE TX","code_information":[{"code":"52343","type":"CPT"}],"standard_charges":[{"minimum":355.47,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTO/URETERO STRICTURE TX","code_information":[{"code":"52344","type":"CPT"}],"standard_charges":[{"minimum":382.29,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTO/URETERO W/UP STRICTURE","code_information":[{"code":"52345","type":"CPT"}],"standard_charges":[{"minimum":408.04,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETERO W/RENAL STRICT","code_information":[{"code":"52346","type":"CPT"}],"standard_charges":[{"minimum":461.33,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETERO  OR PYELOSCOPE","code_information":[{"code":"52351","type":"CPT"}],"standard_charges":[{"minimum":313.27,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETERO W/STONE REMOVE","code_information":[{"code":"52352","type":"CPT"}],"standard_charges":[{"minimum":366.2,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETERO W/LITHOTRIPSY","code_information":[{"code":"52353","type":"CPT"}],"standard_charges":[{"minimum":405.18,"maximum":12318,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETERO W/BIOPSY","code_information":[{"code":"52354","type":"CPT"}],"standard_charges":[{"minimum":430.93,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETERO W/EXCISE TUMOR","code_information":[{"code":"52355","type":"CPT"}],"standard_charges":[{"minimum":483.14,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTO/URETERO W/LITHOTRIPSY","code_information":[{"code":"52356","type":"CPT"}],"standard_charges":[{"minimum":429.86,"maximum":12318,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETERO W/CONGEN REPR","code_information":[{"code":"52400","type":"CPT"}],"standard_charges":[{"minimum":499.23,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETHRO CUT EJACUL DUCT","code_information":[{"code":"52402","type":"CPT"}],"standard_charges":[{"minimum":274.29,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETHRO W/IMPLANT","code_information":[{"code":"52441","type":"CPT"}],"standard_charges":[{"minimum":217.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.07,"methodology":"fee schedule"}]}]},{"description":"CYSTOURETHRO W/ADDL IMPLANT","code_information":[{"code":"52442","type":"CPT"}],"standard_charges":[{"minimum":52.21,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"}]}]},{"description":"INCISION OF PROSTATE","code_information":[{"code":"52450","type":"CPT"}],"standard_charges":[{"minimum":500.66,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISION OF BLADDER NECK","code_information":[{"code":"52500","type":"CPT"}],"standard_charges":[{"minimum":519.62,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"PROSTATECTOMY (TURP)","code_information":[{"code":"52601","type":"CPT"}],"standard_charges":[{"minimum":762.44,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REMOVE PROSTATE REGROWTH","code_information":[{"code":"52630","type":"CPT"}],"standard_charges":[{"minimum":427.71,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RELIEVE BLADDER CONTRACTURE","code_information":[{"code":"52640","type":"CPT"}],"standard_charges":[{"minimum":341.52,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"LASER SURGERY OF PROSTATE","code_information":[{"code":"52647","type":"CPT"}],"standard_charges":[{"minimum":682.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"LASER SURGERY OF PROSTATE","code_information":[{"code":"52648","type":"CPT"}],"standard_charges":[{"minimum":727.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":727.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"PROSTATE LASER ENUCLEATION","code_information":[{"code":"52649","type":"CPT"}],"standard_charges":[{"minimum":864.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PROSTATE ABSCESS","code_information":[{"code":"52700","type":"CPT"}],"standard_charges":[{"minimum":465.97,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"INCISION OF URETHRA","code_information":[{"code":"53000","type":"CPT"}],"standard_charges":[{"minimum":156.64,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"INCISION OF URETHRA","code_information":[{"code":"53010","type":"CPT"}],"standard_charges":[{"minimum":314.7,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"INCISION OF URETHRA","code_information":[{"code":"53020","type":"CPT"}],"standard_charges":[{"minimum":100.85,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"INCISION OF URETHRA","code_information":[{"code":"53025","type":"CPT"}],"standard_charges":[{"minimum":71.88,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF URETHRA ABSCESS","code_information":[{"code":"53040","type":"CPT"}],"standard_charges":[{"minimum":413.41,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF URETHRA ABSCESS","code_information":[{"code":"53060","type":"CPT"}],"standard_charges":[{"minimum":174.87,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF URINARY LEAKAGE","code_information":[{"code":"53080","type":"CPT"}],"standard_charges":[{"minimum":443.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF URINARY LEAKAGE","code_information":[{"code":"53085","type":"CPT"}],"standard_charges":[{"minimum":680.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF URETHRA","code_information":[{"code":"53200","type":"CPT"}],"standard_charges":[{"minimum":148.41,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETHRA","code_information":[{"code":"53210","type":"CPT"}],"standard_charges":[{"minimum":813.58,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETHRA","code_information":[{"code":"53215","type":"CPT"}],"standard_charges":[{"minimum":968.43,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":968.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF URETHRA LESION","code_information":[{"code":"53220","type":"CPT"}],"standard_charges":[{"minimum":476.35,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETHRA LESION","code_information":[{"code":"53230","type":"CPT"}],"standard_charges":[{"minimum":641.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETHRA LESION","code_information":[{"code":"53235","type":"CPT"}],"standard_charges":[{"minimum":666.6,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"SURGERY FOR URETHRA POUCH","code_information":[{"code":"53240","type":"CPT"}],"standard_charges":[{"minimum":448.09,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETHRA GLAND","code_information":[{"code":"53250","type":"CPT"}],"standard_charges":[{"minimum":418.05,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF URETHRA LESION","code_information":[{"code":"53260","type":"CPT"}],"standard_charges":[{"minimum":190.97,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF URETHRA LESION","code_information":[{"code":"53265","type":"CPT"}],"standard_charges":[{"minimum":198.48,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETHRA GLAND","code_information":[{"code":"53270","type":"CPT"}],"standard_charges":[{"minimum":194.54,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETHRA DEFECT","code_information":[{"code":"53275","type":"CPT"}],"standard_charges":[{"minimum":275.72,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISE URETHRA STAGE 1","code_information":[{"code":"53400","type":"CPT"}],"standard_charges":[{"minimum":838.61,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REVISE URETHRA STAGE 2","code_information":[{"code":"53405","type":"CPT"}],"standard_charges":[{"minimum":914.07,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"53410","type":"CPT"}],"standard_charges":[{"minimum":1024.57,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"53415","type":"CPT"}],"standard_charges":[{"minimum":1179.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1179.06,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT URETHRA STAGE 1","code_information":[{"code":"53420","type":"CPT"}],"standard_charges":[{"minimum":879.74,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT URETHRA STAGE 2","code_information":[{"code":"53425","type":"CPT"}],"standard_charges":[{"minimum":978.44,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"53430","type":"CPT"}],"standard_charges":[{"minimum":1019.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT URETHRA/BLADDER","code_information":[{"code":"53431","type":"CPT"}],"standard_charges":[{"minimum":1203.02,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"MALE SLING PROCEDURE","code_information":[{"code":"53440","type":"CPT"}],"standard_charges":[{"minimum":789.26,"maximum":14263.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13986.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14263.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14124.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14193.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"}]}]},{"description":"REMOVE/REVISE MALE SLING","code_information":[{"code":"53442","type":"CPT"}],"standard_charges":[{"minimum":825.38,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"INSERT TANDEM CUFF","code_information":[{"code":"53444","type":"CPT"}],"standard_charges":[{"minimum":831.1,"maximum":22097.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21667.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22097.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21882.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21989.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"}]}]},{"description":"INSERT URO/VES NCK SPHINCTER","code_information":[{"code":"53445","type":"CPT"}],"standard_charges":[{"minimum":794.98,"maximum":22097.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21667.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22097.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21882.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21989.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"}]}]},{"description":"REMOVE URO SPHINCTER","code_information":[{"code":"53446","type":"CPT"}],"standard_charges":[{"minimum":675.54,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REMOVE/REPLACE UR SPHINCTER","code_information":[{"code":"53447","type":"CPT"}],"standard_charges":[{"minimum":845.05,"maximum":22097.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21667.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22097.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21882.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21989.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"}]}]},{"description":"REMOV/REPLC UR SPHINCTR COMP","code_information":[{"code":"53448","type":"CPT"}],"standard_charges":[{"minimum":1331.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.05,"methodology":"fee schedule"}]}]},{"description":"REPAIR URO SPHINCTER","code_information":[{"code":"53449","type":"CPT"}],"standard_charges":[{"minimum":644.07,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":644.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":644.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":644.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"REVISION OF URETHRA","code_information":[{"code":"53450","type":"CPT"}],"standard_charges":[{"minimum":431.29,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISION OF URETHRA","code_information":[{"code":"53460","type":"CPT"}],"standard_charges":[{"minimum":482.43,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"URETHRLYS TRANSVAG W/ SCOPE","code_information":[{"code":"53500","type":"CPT"}],"standard_charges":[{"minimum":785.33,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETHRA INJURY","code_information":[{"code":"53502","type":"CPT"}],"standard_charges":[{"minimum":512.47,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETHRA INJURY","code_information":[{"code":"53505","type":"CPT"}],"standard_charges":[{"minimum":512.11,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETHRA INJURY","code_information":[{"code":"53510","type":"CPT"}],"standard_charges":[{"minimum":664.81,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETHRA INJURY","code_information":[{"code":"53515","type":"CPT"}],"standard_charges":[{"minimum":832.89,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETHRA DEFECT","code_information":[{"code":"53520","type":"CPT"}],"standard_charges":[{"minimum":589,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":589,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":589,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":589,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53600","type":"CPT"}],"standard_charges":[{"minimum":66.16,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":565.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53601","type":"CPT"}],"standard_charges":[{"minimum":55.43,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53605","type":"CPT"}],"standard_charges":[{"minimum":66.52,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53620","type":"CPT"}],"standard_charges":[{"minimum":90.48,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53621","type":"CPT"}],"standard_charges":[{"minimum":74.74,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"DILATION OF URETHRA","code_information":[{"code":"53660","type":"CPT"}],"standard_charges":[{"minimum":43.63,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"DILATION OF URETHRA","code_information":[{"code":"53661","type":"CPT"}],"standard_charges":[{"minimum":42.2,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"DILATION OF URETHRA","code_information":[{"code":"53665","type":"CPT"}],"standard_charges":[{"minimum":39.34,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"PROSTATIC MICROWAVE THERMOTX","code_information":[{"code":"53850","type":"CPT"}],"standard_charges":[{"minimum":375.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"PROSTATIC RF THERMOTX","code_information":[{"code":"53852","type":"CPT"}],"standard_charges":[{"minimum":402.32,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"TRURL DSTRJ PRST8 TISS RF WV","code_information":[{"code":"53854","type":"CPT"}],"standard_charges":[{"minimum":402.32,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"INSERT PROST URETHRAL STENT","code_information":[{"code":"53855","type":"CPT"}],"standard_charges":[{"minimum":85.11,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"TRANSURETHRAL RF TREATMENT","code_information":[{"code":"53860","type":"CPT"}],"standard_charges":[{"minimum":2183.34,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"UROLOGY SURGERY PROCEDURE","code_information":[{"code":"53899","type":"CPT"}],"standard_charges":[{"minimum":197.77,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"SLITTING OF PREPUCE","code_information":[{"code":"54000","type":"CPT"}],"standard_charges":[{"minimum":117.3,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"SLITTING OF PREPUCE","code_information":[{"code":"54001","type":"CPT"}],"standard_charges":[{"minimum":148.41,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"DRAIN PENIS LESION","code_information":[{"code":"54015","type":"CPT"}],"standard_charges":[{"minimum":320.07,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION PENIS LESION(S)","code_information":[{"code":"54050","type":"CPT"}],"standard_charges":[{"minimum":113.01,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION PENIS LESION(S)","code_information":[{"code":"54055","type":"CPT"}],"standard_charges":[{"minimum":101.56,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"CRYOSURGERY PENIS LESION(S)","code_information":[{"code":"54056","type":"CPT"}],"standard_charges":[{"minimum":118.37,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"LASER SURG PENIS LESION(S)","code_information":[{"code":"54057","type":"CPT"}],"standard_charges":[{"minimum":103.71,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF PENIS LESION(S)","code_information":[{"code":"54060","type":"CPT"}],"standard_charges":[{"minimum":139.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION PENIS LESION(S)","code_information":[{"code":"54065","type":"CPT"}],"standard_charges":[{"minimum":181.31,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF PENIS","code_information":[{"code":"54100","type":"CPT"}],"standard_charges":[{"minimum":127.31,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF PENIS","code_information":[{"code":"54105","type":"CPT"}],"standard_charges":[{"minimum":224.23,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54110","type":"CPT"}],"standard_charges":[{"minimum":655.87,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"TREAT PENIS LESION GRAFT","code_information":[{"code":"54111","type":"CPT"}],"standard_charges":[{"minimum":836.82,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"TREAT PENIS LESION GRAFT","code_information":[{"code":"54112","type":"CPT"}],"standard_charges":[{"minimum":980.94,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54115","type":"CPT"}],"standard_charges":[{"minimum":450.6,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF PENIS","code_information":[{"code":"54120","type":"CPT"}],"standard_charges":[{"minimum":665.17,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":665.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":665.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":665.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PENIS","code_information":[{"code":"54125","type":"CPT"}],"standard_charges":[{"minimum":861.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.86,"methodology":"fee schedule"}]}]},{"description":"REMOVE PENIS  NODES","code_information":[{"code":"54130","type":"CPT"}],"standard_charges":[{"minimum":1246.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE PENIS  NODES","code_information":[{"code":"54135","type":"CPT"}],"standard_charges":[{"minimum":1573.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1573.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1573.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1573.87,"methodology":"fee schedule"}]}]},{"description":"CIRCUMCISION W/REGIONL BLOCK","code_information":[{"code":"54150","type":"CPT"}],"standard_charges":[{"minimum":1530.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"CIRCUMCISION NEONATE","code_information":[{"code":"54160","type":"CPT"}],"standard_charges":[{"minimum":711.4,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":718.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":732.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":725.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":729.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"}]}]},{"description":"CIRCUM 28 DAYS OR OLDER","code_information":[{"code":"54161","type":"CPT"}],"standard_charges":[{"minimum":207.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"LYSIS PENIL CIRCUMIC LESION","code_information":[{"code":"54162","type":"CPT"}],"standard_charges":[{"minimum":210.99,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF CIRCUMCISION","code_information":[{"code":"54163","type":"CPT"}],"standard_charges":[{"minimum":231.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"FRENULOTOMY OF PENIS","code_information":[{"code":"54164","type":"CPT"}],"standard_charges":[{"minimum":205.63,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54200","type":"CPT"}],"standard_charges":[{"minimum":92.27,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54205","type":"CPT"}],"standard_charges":[{"minimum":560.74,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54220","type":"CPT"}],"standard_charges":[{"minimum":140.54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"PREPARE PENIS STUDY","code_information":[{"code":"54230","type":"CPT"}],"standard_charges":[{"minimum":83.32,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"}]}]},{"description":"DYNAMIC CAVERNOSOMETRY","code_information":[{"code":"54231","type":"CPT"}],"standard_charges":[{"minimum":121.23,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"PENILE INJECTION","code_information":[{"code":"54235","type":"CPT"}],"standard_charges":[{"minimum":77.6,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"PENIS STUDY","code_information":[{"code":"54240","type":"CPT"}],"standard_charges":[{"minimum":112.65,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":341.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":338.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"}]}]},{"description":"PENIS STUDY","code_information":[{"code":"54250","type":"CPT"}],"standard_charges":[{"minimum":127.67,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":366.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54300","type":"CPT"}],"standard_charges":[{"minimum":677.68,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54304","type":"CPT"}],"standard_charges":[{"minimum":783.9,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54308","type":"CPT"}],"standard_charges":[{"minimum":751.35,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54312","type":"CPT"}],"standard_charges":[{"minimum":857.92,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54316","type":"CPT"}],"standard_charges":[{"minimum":1039.59,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1039.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54318","type":"CPT"}],"standard_charges":[{"minimum":747.42,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54322","type":"CPT"}],"standard_charges":[{"minimum":818.23,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54324","type":"CPT"}],"standard_charges":[{"minimum":1012.77,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54326","type":"CPT"}],"standard_charges":[{"minimum":985.95,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":985.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":985.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":985.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISE PENIS/URETHRA","code_information":[{"code":"54328","type":"CPT"}],"standard_charges":[{"minimum":979.51,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISE PENIS/URETHRA","code_information":[{"code":"54332","type":"CPT"}],"standard_charges":[{"minimum":1056.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISE PENIS/URETHRA","code_information":[{"code":"54336","type":"CPT"}],"standard_charges":[{"minimum":1241.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1241.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"SECONDARY URETHRAL SURGERY","code_information":[{"code":"54340","type":"CPT"}],"standard_charges":[{"minimum":599.37,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"SECONDARY URETHRAL SURGERY","code_information":[{"code":"54344","type":"CPT"}],"standard_charges":[{"minimum":988.1,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"SECONDARY URETHRAL SURGERY","code_information":[{"code":"54348","type":"CPT"}],"standard_charges":[{"minimum":1056.4,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCT URETHRA/PENIS","code_information":[{"code":"54352","type":"CPT"}],"standard_charges":[{"minimum":1474.45,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1474.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"PENIS PLASTIC SURGERY","code_information":[{"code":"54360","type":"CPT"}],"standard_charges":[{"minimum":756.36,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR PENIS","code_information":[{"code":"54380","type":"CPT"}],"standard_charges":[{"minimum":837.9,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR PENIS","code_information":[{"code":"54385","type":"CPT"}],"standard_charges":[{"minimum":974.86,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":974.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR PENIS AND BLADDER","code_information":[{"code":"54390","type":"CPT"}],"standard_charges":[{"minimum":1296,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"}]}]},{"description":"INSERT SEMI-RIGID PROSTHESIS","code_information":[{"code":"54400","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":14263.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13986.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14263.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14124.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14193.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"}]}]},{"description":"INSERT SELF-CONTD PROSTHESIS","code_information":[{"code":"54401","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":22097.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21667.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22097.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21882.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21989.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"}]}]},{"description":"INSERT MULTI-COMP PENIS PROS","code_information":[{"code":"54405","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":22097.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21667.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22097.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21882.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21989.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"}]}]},{"description":"REMOVE MUTI-COMP PENIS PROS","code_information":[{"code":"54406","type":"CPT"}],"standard_charges":[{"minimum":767.45,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR MULTI-COMP PENIS PROS","code_information":[{"code":"54408","type":"CPT"}],"standard_charges":[{"minimum":830.03,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REMOVE/REPLACE PENIS PROSTH","code_information":[{"code":"54410","type":"CPT"}],"standard_charges":[{"minimum":905.49,"maximum":22097.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":905.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":905.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":905.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21667.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22097.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21882.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21989.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"}]}]},{"description":"REMOV/REPLC PENIS PROS COMP","code_information":[{"code":"54411","type":"CPT"}],"standard_charges":[{"minimum":1077.14,"maximum":22097.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21667.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22097.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21882.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21989.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"}]}]},{"description":"REMOVE SELF-CONTD PENIS PROS","code_information":[{"code":"54415","type":"CPT"}],"standard_charges":[{"minimum":561.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMV/REPL PENIS CONTAIN PROS","code_information":[{"code":"54416","type":"CPT"}],"standard_charges":[{"minimum":754.57,"maximum":22097.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21667.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22097.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21882.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21989.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21453.42,"methodology":"fee schedule"}]}]},{"description":"REMV/REPLC PENIS PROS COMPL","code_information":[{"code":"54417","type":"CPT"}],"standard_charges":[{"minimum":941.61,"maximum":14263.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13986.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14263.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14124.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14193.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13847.58,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54420","type":"CPT"}],"standard_charges":[{"minimum":737.41,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54430","type":"CPT"}],"standard_charges":[{"minimum":671.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.25,"methodology":"fee schedule"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54435","type":"CPT"}],"standard_charges":[{"minimum":437.37,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPAIR CORPOREAL TEAR","code_information":[{"code":"54437","type":"CPT"}],"standard_charges":[{"minimum":714.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REPLANTATION OF PENIS","code_information":[{"code":"54438","type":"CPT"}],"standard_charges":[{"minimum":1395.06,"maximum":1395.06,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1395.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1395.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1395.06,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF PENIS","code_information":[{"code":"54440","type":"CPT"}],"standard_charges":[{"minimum":718.68,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"PREPUTIAL STRETCHING","code_information":[{"code":"54450","type":"CPT"}],"standard_charges":[{"minimum":59.36,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF TESTIS","code_information":[{"code":"54500","type":"CPT"}],"standard_charges":[{"minimum":77.96,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF TESTIS","code_information":[{"code":"54505","type":"CPT"}],"standard_charges":[{"minimum":220.29,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"EXCISE LESION TESTIS","code_information":[{"code":"54512","type":"CPT"}],"standard_charges":[{"minimum":565.75,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TESTIS","code_information":[{"code":"54520","type":"CPT"}],"standard_charges":[{"minimum":346.53,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"ORCHIECTOMY PARTIAL","code_information":[{"code":"54522","type":"CPT"}],"standard_charges":[{"minimum":617.6,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TESTIS","code_information":[{"code":"54530","type":"CPT"}],"standard_charges":[{"minimum":536.43,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE TESTIS SURGERY","code_information":[{"code":"54535","type":"CPT"}],"standard_charges":[{"minimum":781.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION FOR TESTIS","code_information":[{"code":"54550","type":"CPT"}],"standard_charges":[{"minimum":518.19,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION FOR TESTIS","code_information":[{"code":"54560","type":"CPT"}],"standard_charges":[{"minimum":721.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REDUCE TESTIS TORSION","code_information":[{"code":"54600","type":"CPT"}],"standard_charges":[{"minimum":477.78,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"SUSPENSION OF TESTIS","code_information":[{"code":"54620","type":"CPT"}],"standard_charges":[{"minimum":313.27,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"ORCHIOPEXY INGUN/SCROT APPR","code_information":[{"code":"54640","type":"CPT"}],"standard_charges":[{"minimum":453.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"ORCHIOPEXY (FOWLER-STEPHENS)","code_information":[{"code":"54650","type":"CPT"}],"standard_charges":[{"minimum":748.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REVISION OF TESTIS","code_information":[{"code":"54660","type":"CPT"}],"standard_charges":[{"minimum":379.07,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR TESTIS INJURY","code_information":[{"code":"54670","type":"CPT"}],"standard_charges":[{"minimum":432,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"RELOCATION OF TESTIS(ES)","code_information":[{"code":"54680","type":"CPT"}],"standard_charges":[{"minimum":825.38,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY ORCHIECTOMY","code_information":[{"code":"54690","type":"CPT"}],"standard_charges":[{"minimum":687.7,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY ORCHIOPEXY","code_information":[{"code":"54692","type":"CPT"}],"standard_charges":[{"minimum":791.05,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPE PROC TESTIS","code_information":[{"code":"54699","type":"CPT"}],"standard_charges":[{"minimum":2897.78,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SCROTUM","code_information":[{"code":"54700","type":"CPT"}],"standard_charges":[{"minimum":224.58,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF EPIDIDYMIS","code_information":[{"code":"54800","type":"CPT"}],"standard_charges":[{"minimum":130.89,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVE EPIDIDYMIS LESION","code_information":[{"code":"54830","type":"CPT"}],"standard_charges":[{"minimum":393.74,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVE EPIDIDYMIS LESION","code_information":[{"code":"54840","type":"CPT"}],"standard_charges":[{"minimum":340.09,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EPIDIDYMIS","code_information":[{"code":"54860","type":"CPT"}],"standard_charges":[{"minimum":442.37,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EPIDIDYMIS","code_information":[{"code":"54861","type":"CPT"}],"standard_charges":[{"minimum":598.65,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"EXPLORE EPIDIDYMIS","code_information":[{"code":"54865","type":"CPT"}],"standard_charges":[{"minimum":380.86,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"FUSION OF SPERMATIC DUCTS","code_information":[{"code":"54900","type":"CPT"}],"standard_charges":[{"minimum":838.97,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"FUSION OF SPERMATIC DUCTS","code_information":[{"code":"54901","type":"CPT"}],"standard_charges":[{"minimum":1106.47,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF HYDROCELE","code_information":[{"code":"55000","type":"CPT"}],"standard_charges":[{"minimum":88.69,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HYDROCELE","code_information":[{"code":"55040","type":"CPT"}],"standard_charges":[{"minimum":357.97,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HYDROCELES","code_information":[{"code":"55041","type":"CPT"}],"standard_charges":[{"minimum":539.64,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HYDROCELE","code_information":[{"code":"55060","type":"CPT"}],"standard_charges":[{"minimum":401.25,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SCROTUM ABSCESS","code_information":[{"code":"55100","type":"CPT"}],"standard_charges":[{"minimum":177.38,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"EXPLORE SCROTUM","code_information":[{"code":"55110","type":"CPT"}],"standard_charges":[{"minimum":409.83,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SCROTUM LESION","code_information":[{"code":"55120","type":"CPT"}],"standard_charges":[{"minimum":375.86,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SCROTUM","code_information":[{"code":"55150","type":"CPT"}],"standard_charges":[{"minimum":519.62,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISION OF SCROTUM","code_information":[{"code":"55175","type":"CPT"}],"standard_charges":[{"minimum":385.51,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISION OF SCROTUM","code_information":[{"code":"55180","type":"CPT"}],"standard_charges":[{"minimum":723.82,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"INCISION OF SPERM DUCT","code_information":[{"code":"55200","type":"CPT"}],"standard_charges":[{"minimum":293.25,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SPERM DUCT(S)","code_information":[{"code":"55250","type":"CPT"}],"standard_charges":[{"minimum":242.82,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"PREPARE SPERM DUCT X-RAY","code_information":[{"code":"55300","type":"CPT"}],"standard_charges":[{"minimum":193.47,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SPERM DUCT","code_information":[{"code":"55400","type":"CPT"}],"standard_charges":[{"minimum":1530.45,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF HYDROCELE","code_information":[{"code":"55500","type":"CPT"}],"standard_charges":[{"minimum":413.41,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SPERM CORD LESION","code_information":[{"code":"55520","type":"CPT"}],"standard_charges":[{"minimum":482.78,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISE SPERMATIC CORD VEINS","code_information":[{"code":"55530","type":"CPT"}],"standard_charges":[{"minimum":371.92,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REVISE SPERMATIC CORD VEINS","code_information":[{"code":"55535","type":"CPT"}],"standard_charges":[{"minimum":454.17,"maximum":6849.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6716.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6849.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6783.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6816.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"fee schedule"}]}]},{"description":"REVISE HERNIA  SPERM VEINS","code_information":[{"code":"55540","type":"CPT"}],"standard_charges":[{"minimum":583.63,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3798.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3874.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3836.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3855.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3761.34,"methodology":"fee schedule"}]}]},{"description":"LAPARO LIGATE SPERMATIC VEIN","code_information":[{"code":"55550","type":"CPT"}],"standard_charges":[{"minimum":453.46,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO PROC SPERMATIC CORD","code_information":[{"code":"55559","type":"CPT"}],"standard_charges":[{"minimum":2049.5,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"INCISE SPERM DUCT POUCH","code_information":[{"code":"55600","type":"CPT"}],"standard_charges":[{"minimum":445.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"INCISE SPERM DUCT POUCH","code_information":[{"code":"55605","type":"CPT"}],"standard_charges":[{"minimum":552.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPERM DUCT POUCH","code_information":[{"code":"55650","type":"CPT"}],"standard_charges":[{"minimum":753.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.86,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPERM POUCH LESION","code_information":[{"code":"55680","type":"CPT"}],"standard_charges":[{"minimum":366.92,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF PROSTATE","code_information":[{"code":"55700","type":"CPT"}],"standard_charges":[{"minimum":135.54,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2205.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2248.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2227.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2237.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF PROSTATE","code_information":[{"code":"55705","type":"CPT"}],"standard_charges":[{"minimum":277.87,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"PROSTATE SATURATION SAMPLING","code_information":[{"code":"55706","type":"CPT"}],"standard_charges":[{"minimum":394.81,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PROSTATE ABSCESS","code_information":[{"code":"55720","type":"CPT"}],"standard_charges":[{"minimum":476.35,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PROSTATE ABSCESS","code_information":[{"code":"55725","type":"CPT"}],"standard_charges":[{"minimum":627.62,"maximum":3786.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PROSTATE","code_information":[{"code":"55801","type":"CPT"}],"standard_charges":[{"minimum":1144.73,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.73,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55810","type":"CPT"}],"standard_charges":[{"minimum":1362.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.52,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55812","type":"CPT"}],"standard_charges":[{"minimum":1674.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1674.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1674.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1674.72,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55815","type":"CPT"}],"standard_charges":[{"minimum":1832.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1832.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1832.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1832.79,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PROSTATE","code_information":[{"code":"55821","type":"CPT"}],"standard_charges":[{"minimum":877.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.95,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PROSTATE","code_information":[{"code":"55831","type":"CPT"}],"standard_charges":[{"minimum":900.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.12,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55840","type":"CPT"}],"standard_charges":[{"minimum":1221.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1221.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1221.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1221.98,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55842","type":"CPT"}],"standard_charges":[{"minimum":1221.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1221.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1221.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1221.26,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55845","type":"CPT"}],"standard_charges":[{"minimum":1420.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.1,"methodology":"fee schedule"}]}]},{"description":"SURGICAL EXPOSURE PROSTATE","code_information":[{"code":"55860","type":"CPT"}],"standard_charges":[{"minimum":914.78,"maximum":5580.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55862","type":"CPT"}],"standard_charges":[{"minimum":1143.66,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1143.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1143.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1143.66,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55865","type":"CPT"}],"standard_charges":[{"minimum":1391.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1391.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1391.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1391.85,"methodology":"fee schedule"}]}]},{"description":"LAPARO RADICAL PROSTATECTOMY","code_information":[{"code":"55866","type":"CPT"}],"standard_charges":[{"minimum":1247.01,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"ELECTROEJACULATION","code_information":[{"code":"55870","type":"CPT"}],"standard_charges":[{"minimum":148.05,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"CRYOABLATE PROSTATE","code_information":[{"code":"55873","type":"CPT"}],"standard_charges":[{"minimum":801.42,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"TPRNL PLMT BIODEGRDABL MATRL","code_information":[{"code":"55874","type":"CPT"}],"standard_charges":[{"minimum":171.3,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"TRANSPERI NEEDLE PLACE PROS","code_information":[{"code":"55875","type":"CPT"}],"standard_charges":[{"minimum":818.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5472.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5580.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5526.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5553.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5418.22,"methodology":"fee schedule"}]}]},{"description":"PLACE RT DEVICE/MARKER PROS","code_information":[{"code":"55876","type":"CPT"}],"standard_charges":[{"minimum":106.93,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1472.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1502.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1487.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1494.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1458.32,"methodology":"fee schedule"}]}]},{"description":"ABLTJ MAL PRST8 TISS HIFU","code_information":[{"code":"55880","type":"CPT"}],"standard_charges":[{"minimum":1024.93,"maximum":10151.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9954.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10052.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9855.8,"methodology":"fee schedule"}]}]},{"description":"GENITAL SURGERY PROCEDURE","code_information":[{"code":"55899","type":"CPT"}],"standard_charges":[{"minimum":197.77,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":267,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":264.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":259.22,"methodology":"fee schedule"}]}]},{"description":"PLACE NEEDLES PELVIC FOR RT","code_information":[{"code":"55920","type":"CPT"}],"standard_charges":[{"minimum":482.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"SEX TRANSFORMATION M TO F","code_information":[{"code":"55970","type":"CPT"}],"standard_charges":[{"minimum":4573.57,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"SEX TRANSFORMATION F TO M","code_information":[{"code":"55980","type":"CPT"}],"standard_charges":[{"minimum":3675.98,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3712.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3786.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3749.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3767.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3675.98,"methodology":"fee schedule"}]}]},{"description":"I  D OF VULVA/PERINEUM","code_information":[{"code":"56405","type":"CPT"}],"standard_charges":[{"minimum":134.46,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF GLAND ABSCESS","code_information":[{"code":"56420","type":"CPT"}],"standard_charges":[{"minimum":116.94,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"SURGERY FOR VULVA LESION","code_information":[{"code":"56440","type":"CPT"}],"standard_charges":[{"minimum":192.04,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"LYSIS OF LABIAL LESION(S)","code_information":[{"code":"56441","type":"CPT"}],"standard_charges":[{"minimum":164.5,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"HYMENOTOMY","code_information":[{"code":"56442","type":"CPT"}],"standard_charges":[{"minimum":50.07,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DESTROY VULVA LESIONS SIM","code_information":[{"code":"56501","type":"CPT"}],"standard_charges":[{"minimum":141.62,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"DESTROY VULVA LESION/S COMPL","code_information":[{"code":"56515","type":"CPT"}],"standard_charges":[{"minimum":224.94,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1969.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2008.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1998.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1949.63,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF VULVA/PERINEUM","code_information":[{"code":"56605","type":"CPT"}],"standard_charges":[{"minimum":61.87,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF VULVA/PERINEUM","code_information":[{"code":"56606","type":"CPT"}],"standard_charges":[{"minimum":30.4,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF VULVA","code_information":[{"code":"56620","type":"CPT"}],"standard_charges":[{"minimum":622.25,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"COMPLETE REMOVAL OF VULVA","code_information":[{"code":"56625","type":"CPT"}],"standard_charges":[{"minimum":708.08,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56630","type":"CPT"}],"standard_charges":[{"minimum":1015.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56631","type":"CPT"}],"standard_charges":[{"minimum":1254.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1254.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1254.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1254.16,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56632","type":"CPT"}],"standard_charges":[{"minimum":1516.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1516.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1516.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1516.3,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56633","type":"CPT"}],"standard_charges":[{"minimum":1309.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.24,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56634","type":"CPT"}],"standard_charges":[{"minimum":1369.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1369.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1369.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1369.32,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56637","type":"CPT"}],"standard_charges":[{"minimum":1603.55,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1603.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1603.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1603.55,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56640","type":"CPT"}],"standard_charges":[{"minimum":1611.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1611.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1611.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1611.78,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF HYMEN","code_information":[{"code":"56700","type":"CPT"}],"standard_charges":[{"minimum":214.93,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGINA GLAND LESION","code_information":[{"code":"56740","type":"CPT"}],"standard_charges":[{"minimum":332.58,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF VAGINA","code_information":[{"code":"56800","type":"CPT"}],"standard_charges":[{"minimum":267.86,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REPAIR CLITORIS","code_information":[{"code":"56805","type":"CPT"}],"standard_charges":[{"minimum":1227.34,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1227.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1227.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1227.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF PERINEUM","code_information":[{"code":"56810","type":"CPT"}],"standard_charges":[{"minimum":288.6,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"EXAM OF VULVA W/SCOPE","code_information":[{"code":"56820","type":"CPT"}],"standard_charges":[{"minimum":88.33,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"EXAM/BIOPSY OF VULVA W/SCOPE","code_information":[{"code":"56821","type":"CPT"}],"standard_charges":[{"minimum":118.73,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF VAGINA","code_information":[{"code":"57000","type":"CPT"}],"standard_charges":[{"minimum":213.5,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PELVIC ABSCESS","code_information":[{"code":"57010","type":"CPT"}],"standard_charges":[{"minimum":484.57,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF PELVIC FLUID","code_information":[{"code":"57020","type":"CPT"}],"standard_charges":[{"minimum":82.97,"maximum":5419.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"I  D VAGINAL HEMATOMA PP","code_information":[{"code":"57022","type":"CPT"}],"standard_charges":[{"minimum":191.68,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"I  D VAG HEMATOMA NON-OB","code_information":[{"code":"57023","type":"CPT"}],"standard_charges":[{"minimum":337.95,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"DESTROY VAG LESIONS SIMPLE","code_information":[{"code":"57061","type":"CPT"}],"standard_charges":[{"minimum":122.31,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DESTROY VAG LESIONS COMPLEX","code_information":[{"code":"57065","type":"CPT"}],"standard_charges":[{"minimum":196.69,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF VAGINA","code_information":[{"code":"57100","type":"CPT"}],"standard_charges":[{"minimum":68.66,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF VAGINA","code_information":[{"code":"57105","type":"CPT"}],"standard_charges":[{"minimum":155.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGINA WALL PARTIAL","code_information":[{"code":"57106","type":"CPT"}],"standard_charges":[{"minimum":568.97,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGINA TISSUE PART","code_information":[{"code":"57107","type":"CPT"}],"standard_charges":[{"minimum":1537.4,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1537.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1537.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1537.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"VAGINECTOMY PARTIAL W/NODES","code_information":[{"code":"57109","type":"CPT"}],"standard_charges":[{"minimum":1826.35,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1826.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1826.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1826.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGINA WALL COMPLETE","code_information":[{"code":"57110","type":"CPT"}],"standard_charges":[{"minimum":951.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.98,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGINA TISSUE COMPL","code_information":[{"code":"57111","type":"CPT"}],"standard_charges":[{"minimum":1826.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1826.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1826.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1826.35,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF VAGINA","code_information":[{"code":"57120","type":"CPT"}],"standard_charges":[{"minimum":561.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGINA LESION","code_information":[{"code":"57130","type":"CPT"}],"standard_charges":[{"minimum":183.1,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGINA LESION","code_information":[{"code":"57135","type":"CPT"}],"standard_charges":[{"minimum":198.84,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"TREAT VAGINA INFECTION","code_information":[{"code":"57150","type":"CPT"}],"standard_charges":[{"minimum":26.82,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"INSERT UTERI TANDEM/OVOIDS","code_information":[{"code":"57155","type":"CPT"}],"standard_charges":[{"minimum":298.25,"maximum":5419.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"INS VAG BRACHYTX DEVICE","code_information":[{"code":"57156","type":"CPT"}],"standard_charges":[{"minimum":159.14,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"INSERT PESSARY/OTHER DEVICE","code_information":[{"code":"57160","type":"CPT"}],"standard_charges":[{"minimum":47.92,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"FITTING OF DIAPHRAGM/CAP","code_information":[{"code":"57170","type":"CPT"}],"standard_charges":[{"minimum":29.86,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"TREAT VAGINAL BLEEDING","code_information":[{"code":"57180","type":"CPT"}],"standard_charges":[{"minimum":128.03,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF VAGINA","code_information":[{"code":"57200","type":"CPT"}],"standard_charges":[{"minimum":352.61,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REPAIR VAGINA/PERINEUM","code_information":[{"code":"57210","type":"CPT"}],"standard_charges":[{"minimum":416.62,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REVISION OF URETHRA","code_information":[{"code":"57220","type":"CPT"}],"standard_charges":[{"minimum":366.56,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF URETHRAL LESION","code_information":[{"code":"57230","type":"CPT"}],"standard_charges":[{"minimum":443.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"ANTERIOR COLPORRHAPHY","code_information":[{"code":"57240","type":"CPT"}],"standard_charges":[{"minimum":647.64,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR RECTUM  VAGINA","code_information":[{"code":"57250","type":"CPT"}],"standard_charges":[{"minimum":650.15,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"CMBN ANT PST COLPRHY","code_information":[{"code":"57260","type":"CPT"}],"standard_charges":[{"minimum":820.73,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"CMBN AP COLPRHY W/NTRCL RPR","code_information":[{"code":"57265","type":"CPT"}],"standard_charges":[{"minimum":917.65,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"INSERT MESH/PELVIC FLR ADDON","code_information":[{"code":"57267","type":"CPT"}],"standard_charges":[{"minimum":261.06,"maximum":6048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.06,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF BOWEL BULGE","code_information":[{"code":"57268","type":"CPT"}],"standard_charges":[{"minimum":536.07,"maximum":5419.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF BOWEL POUCH","code_information":[{"code":"57270","type":"CPT"}],"standard_charges":[{"minimum":857.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":857.57,"methodology":"fee schedule"}]}]},{"description":"SUSPENSION OF VAGINA","code_information":[{"code":"57280","type":"CPT"}],"standard_charges":[{"minimum":1015.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.99,"methodology":"fee schedule"}]}]},{"description":"COLPOPEXY EXTRAPERITONEAL","code_information":[{"code":"57282","type":"CPT"}],"standard_charges":[{"minimum":732.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"COLPOPEXY INTRAPERITONEAL","code_information":[{"code":"57283","type":"CPT"}],"standard_charges":[{"minimum":736.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"REPAIR PARAVAG DEFECT OPEN","code_information":[{"code":"57284","type":"CPT"}],"standard_charges":[{"minimum":877.23,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR PARAVAG DEFECT VAG","code_information":[{"code":"57285","type":"CPT"}],"standard_charges":[{"minimum":730.25,"maximum":8117.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":730.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"REVISE/REMOVE SLING REPAIR","code_information":[{"code":"57287","type":"CPT"}],"standard_charges":[{"minimum":784.25,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLADDER DEFECT","code_information":[{"code":"57288","type":"CPT"}],"standard_charges":[{"minimum":784.61,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6589.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4942.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4942.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLADDER  VAGINA","code_information":[{"code":"57289","type":"CPT"}],"standard_charges":[{"minimum":837.9,"maximum":8117.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCTION OF VAGINA","code_information":[{"code":"57291","type":"CPT"}],"standard_charges":[{"minimum":581.49,"maximum":5419.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"CONSTRUCT VAGINA WITH GRAFT","code_information":[{"code":"57292","type":"CPT"}],"standard_charges":[{"minimum":872.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":872.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":872.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":872.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REVISE VAG GRAFT VIA VAGINA","code_information":[{"code":"57295","type":"CPT"}],"standard_charges":[{"minimum":530.35,"maximum":4392.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REVISE VAG GRAFT OPEN ABD","code_information":[{"code":"57296","type":"CPT"}],"standard_charges":[{"minimum":1008.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.84,"methodology":"fee schedule"}]}]},{"description":"REPAIR RECTUM-VAGINA FISTULA","code_information":[{"code":"57300","type":"CPT"}],"standard_charges":[{"minimum":648,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REPAIR RECTUM-VAGINA FISTULA","code_information":[{"code":"57305","type":"CPT"}],"standard_charges":[{"minimum":1028.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.51,"methodology":"fee schedule"}]}]},{"description":"FISTULA REPAIR  COLOSTOMY","code_information":[{"code":"57307","type":"CPT"}],"standard_charges":[{"minimum":1136.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.86,"methodology":"fee schedule"}]}]},{"description":"FISTULA REPAIR TRANSPERINE","code_information":[{"code":"57308","type":"CPT"}],"standard_charges":[{"minimum":700.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":700.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":700.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":700.93,"methodology":"fee schedule"}]}]},{"description":"REPAIR URETHROVAGINAL LESION","code_information":[{"code":"57310","type":"CPT"}],"standard_charges":[{"minimum":521.76,"maximum":8117.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"REPAIR URETHROVAGINAL LESION","code_information":[{"code":"57311","type":"CPT"}],"standard_charges":[{"minimum":587.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.21,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLADDER-VAGINA LESION","code_information":[{"code":"57320","type":"CPT"}],"standard_charges":[{"minimum":597.22,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR BLADDER-VAGINA LESION","code_information":[{"code":"57330","type":"CPT"}],"standard_charges":[{"minimum":807.14,"maximum":8117.99,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"REPAIR VAGINA","code_information":[{"code":"57335","type":"CPT"}],"standard_charges":[{"minimum":1239.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1239.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1239.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1239.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"DILATION OF VAGINA","code_information":[{"code":"57400","type":"CPT"}],"standard_charges":[{"minimum":136.61,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"PELVIC EXAMINATION","code_information":[{"code":"57410","type":"CPT"}],"standard_charges":[{"minimum":111.58,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGINAL FOREIGN BODY","code_information":[{"code":"57415","type":"CPT"}],"standard_charges":[{"minimum":185.96,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"EXAM OF VAGINA W/SCOPE","code_information":[{"code":"57420","type":"CPT"}],"standard_charges":[{"minimum":94.05,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"EXAM/BIOPSY OF VAG W/SCOPE","code_information":[{"code":"57421","type":"CPT"}],"standard_charges":[{"minimum":127.67,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"REPAIR PARAVAG DEFECT LAP","code_information":[{"code":"57423","type":"CPT"}],"standard_charges":[{"minimum":977.01,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY SURG COLPOPEXY","code_information":[{"code":"57425","type":"CPT"}],"standard_charges":[{"minimum":1023.86,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"REVISE PROSTH VAG GRAFT LAP","code_information":[{"code":"57426","type":"CPT"}],"standard_charges":[{"minimum":921.22,"maximum":8117.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"EXAM OF CERVIX W/SCOPE","code_information":[{"code":"57452","type":"CPT"}],"standard_charges":[{"minimum":95.48,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"BX/CURETT OF CERVIX W/SCOPE","code_information":[{"code":"57454","type":"CPT"}],"standard_charges":[{"minimum":140.19,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF CERVIX W/SCOPE","code_information":[{"code":"57455","type":"CPT"}],"standard_charges":[{"minimum":113.72,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"ENDOCERV CURETTAGE W/SCOPE","code_information":[{"code":"57456","type":"CPT"}],"standard_charges":[{"minimum":105.85,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"BX OF CERVIX W/SCOPE LEEP","code_information":[{"code":"57460","type":"CPT"}],"standard_charges":[{"minimum":167.01,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"CONZ OF CERVIX W/SCOPE LEEP","code_information":[{"code":"57461","type":"CPT"}],"standard_charges":[{"minimum":191.33,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"CAM CERVIX UTERI DRG COLP","code_information":[{"code":"57465","type":"CPT"}],"standard_charges":[{"minimum":44.34,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF CERVIX","code_information":[{"code":"57500","type":"CPT"}],"standard_charges":[{"minimum":79.03,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"ENDOCERVICAL CURETTAGE","code_information":[{"code":"57505","type":"CPT"}],"standard_charges":[{"minimum":115.87,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"CAUTERIZATION OF CERVIX","code_information":[{"code":"57510","type":"CPT"}],"standard_charges":[{"minimum":119.09,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"CRYOCAUTERY OF CERVIX","code_information":[{"code":"57511","type":"CPT"}],"standard_charges":[{"minimum":156.28,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"LASER SURGERY OF CERVIX","code_information":[{"code":"57513","type":"CPT"}],"standard_charges":[{"minimum":155.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"CONIZATION OF CERVIX","code_information":[{"code":"57520","type":"CPT"}],"standard_charges":[{"minimum":314.35,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"CONIZATION OF CERVIX","code_information":[{"code":"57522","type":"CPT"}],"standard_charges":[{"minimum":270.36,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF CERVIX","code_information":[{"code":"57530","type":"CPT"}],"standard_charges":[{"minimum":396.95,"maximum":5419.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF CERVIX RADICAL","code_information":[{"code":"57531","type":"CPT"}],"standard_charges":[{"minimum":1912.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1912.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1912.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1912.54,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RESIDUAL CERVIX","code_information":[{"code":"57540","type":"CPT"}],"standard_charges":[{"minimum":834.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.32,"methodology":"fee schedule"}]}]},{"description":"REMOVE CERVIX/REPAIR PELVIS","code_information":[{"code":"57545","type":"CPT"}],"standard_charges":[{"minimum":879.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.02,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF RESIDUAL CERVIX","code_information":[{"code":"57550","type":"CPT"}],"standard_charges":[{"minimum":457.75,"maximum":5419.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REMOVE CERVIX/REPAIR VAGINA","code_information":[{"code":"57555","type":"CPT"}],"standard_charges":[{"minimum":654.08,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":654.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":654.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":654.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REMOVE CERVIX REPAIR BOWEL","code_information":[{"code":"57556","type":"CPT"}],"standard_charges":[{"minimum":621.18,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":621.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":621.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":621.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"DC OF CERVICAL STUMP","code_information":[{"code":"57558","type":"CPT"}],"standard_charges":[{"minimum":136.61,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CERVIX","code_information":[{"code":"57700","type":"CPT"}],"standard_charges":[{"minimum":378.72,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CERVIX","code_information":[{"code":"57720","type":"CPT"}],"standard_charges":[{"minimum":354.4,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DILATION OF CERVICAL CANAL","code_information":[{"code":"57800","type":"CPT"}],"standard_charges":[{"minimum":50.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF UTERUS LINING","code_information":[{"code":"58100","type":"CPT"}],"standard_charges":[{"minimum":66.16,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"BX DONE W/COLPOSCOPY ADD-ON","code_information":[{"code":"58110","type":"CPT"}],"standard_charges":[{"minimum":41.84,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"}]}]},{"description":"DILATION AND CURETTAGE","code_information":[{"code":"58120","type":"CPT"}],"standard_charges":[{"minimum":246.76,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"MYOMECTOMY ABDOM METHOD","code_information":[{"code":"58140","type":"CPT"}],"standard_charges":[{"minimum":971.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.29,"methodology":"fee schedule"}]}]},{"description":"MYOMECTOMY VAG METHOD","code_information":[{"code":"58145","type":"CPT"}],"standard_charges":[{"minimum":601.87,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"MYOMECTOMY ABDOM COMPLEX","code_information":[{"code":"58146","type":"CPT"}],"standard_charges":[{"minimum":1214.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1214.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1214.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1214.82,"methodology":"fee schedule"}]}]},{"description":"TOTAL HYSTERECTOMY","code_information":[{"code":"58150","type":"CPT"}],"standard_charges":[{"minimum":1070.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1070.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1070.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1070.71,"methodology":"fee schedule"}]}]},{"description":"TOTAL HYSTERECTOMY","code_information":[{"code":"58152","type":"CPT"}],"standard_charges":[{"minimum":1302.08,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.08,"methodology":"fee schedule"}]}]},{"description":"PARTIAL HYSTERECTOMY","code_information":[{"code":"58180","type":"CPT"}],"standard_charges":[{"minimum":1012.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.41,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE HYSTERECTOMY","code_information":[{"code":"58200","type":"CPT"}],"standard_charges":[{"minimum":1419.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1419.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1419.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1419.38,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE HYSTERECTOMY","code_information":[{"code":"58210","type":"CPT"}],"standard_charges":[{"minimum":1916.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.83,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PELVIS CONTENTS","code_information":[{"code":"58240","type":"CPT"}],"standard_charges":[{"minimum":3070.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3070.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3070.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3070.86,"methodology":"fee schedule"}]}]},{"description":"VAGINAL HYSTERECTOMY","code_information":[{"code":"58260","type":"CPT"}],"standard_charges":[{"minimum":884.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"VAG HYST INCLUDING T/O","code_information":[{"code":"58262","type":"CPT"}],"standard_charges":[{"minimum":977.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":977.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"VAG HYST W/T/O  VAG REPAIR","code_information":[{"code":"58263","type":"CPT"}],"standard_charges":[{"minimum":1047.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"VAG HYST W/URINARY REPAIR","code_information":[{"code":"58267","type":"CPT"}],"standard_charges":[{"minimum":1126.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1126.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1126.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1126.85,"methodology":"fee schedule"}]}]},{"description":"VAG HYST W/ENTEROCELE REPAIR","code_information":[{"code":"58270","type":"CPT"}],"standard_charges":[{"minimum":942.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":942.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":942.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":942.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"HYSTERECTOMY/REVISE VAGINA","code_information":[{"code":"58275","type":"CPT"}],"standard_charges":[{"minimum":1044.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.24,"methodology":"fee schedule"}]}]},{"description":"HYSTERECTOMY/REVISE VAGINA","code_information":[{"code":"58280","type":"CPT"}],"standard_charges":[{"minimum":1116.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.48,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE HYSTERECTOMY","code_information":[{"code":"58285","type":"CPT"}],"standard_charges":[{"minimum":1499.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1499.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1499.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1499.85,"methodology":"fee schedule"}]}]},{"description":"VAG HYST COMPLEX","code_information":[{"code":"58290","type":"CPT"}],"standard_charges":[{"minimum":1210.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1210.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1210.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1210.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"VAG HYST INCL T/O COMPLEX","code_information":[{"code":"58291","type":"CPT"}],"standard_charges":[{"minimum":1307.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"VAG HYST T/O  REPAIR COMPL","code_information":[{"code":"58292","type":"CPT"}],"standard_charges":[{"minimum":1378.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1378.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1378.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1378.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"VAG HYST W/ENTEROCELE COMPL","code_information":[{"code":"58294","type":"CPT"}],"standard_charges":[{"minimum":1279.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"INSERT INTRAUTERINE DEVICE","code_information":[{"code":"58300","type":"CPT"}],"standard_charges":[{"minimum":52.93,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE INTRAUTERINE DEVICE","code_information":[{"code":"58301","type":"CPT"}],"standard_charges":[{"minimum":69.38,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"ARTIFICIAL INSEMINATION","code_information":[{"code":"58321","type":"CPT"}],"standard_charges":[{"minimum":324.21,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"ARTIFICIAL INSEMINATION","code_information":[{"code":"58322","type":"CPT"}],"standard_charges":[{"minimum":214.41,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"SPERM WASHING","code_information":[{"code":"58323","type":"CPT"}],"standard_charges":[{"minimum":73.65,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"CATHETER FOR HYSTEROGRAPHY","code_information":[{"code":"58340","type":"CPT"}],"standard_charges":[{"minimum":60.44,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":259.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":259.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.44,"methodology":"fee schedule"}]}]},{"description":"REOPEN FALLOPIAN TUBE","code_information":[{"code":"58345","type":"CPT"}],"standard_charges":[{"minimum":2049.5,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"INSERT HEYMAN UTERI CAPSULE","code_information":[{"code":"58346","type":"CPT"}],"standard_charges":[{"minimum":524.98,"maximum":5419.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REOPEN FALLOPIAN TUBE","code_information":[{"code":"58350","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"ENDOMETR ABLATE THERMAL","code_information":[{"code":"58353","type":"CPT"}],"standard_charges":[{"minimum":243.54,"maximum":6709.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6709.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5033.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5033.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"ENDOMETRIAL CRYOABLATION","code_information":[{"code":"58356","type":"CPT"}],"standard_charges":[{"minimum":371.56,"maximum":6709.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6709.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5033.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5033.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"SUSPENSION OF UTERUS","code_information":[{"code":"58400","type":"CPT"}],"standard_charges":[{"minimum":490.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"}]}]},{"description":"SUSPENSION OF UTERUS","code_information":[{"code":"58410","type":"CPT"}],"standard_charges":[{"minimum":860.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.07,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF RUPTURED UTERUS","code_information":[{"code":"58520","type":"CPT"}],"standard_charges":[{"minimum":842.19,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.19,"methodology":"fee schedule"}]}]},{"description":"REVISION OF UTERUS","code_information":[{"code":"58540","type":"CPT"}],"standard_charges":[{"minimum":966.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.64,"methodology":"fee schedule"}]}]},{"description":"LSH UTERUS 250 G OR LESS","code_information":[{"code":"58541","type":"CPT"}],"standard_charges":[{"minimum":771.02,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LSH W/T/O UT 250 G OR LESS","code_information":[{"code":"58542","type":"CPT"}],"standard_charges":[{"minimum":875.09,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LSH UTERUS ABOVE 250 G","code_information":[{"code":"58543","type":"CPT"}],"standard_charges":[{"minimum":888.32,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LSH W/T/O UTERUS ABOVE 250 G","code_information":[{"code":"58544","type":"CPT"}],"standard_charges":[{"minimum":954.48,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":954.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPIC MYOMECTOMY","code_information":[{"code":"58545","type":"CPT"}],"standard_charges":[{"minimum":950.19,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":950.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":950.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":950.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO-MYOMECTOMY COMPLEX","code_information":[{"code":"58546","type":"CPT"}],"standard_charges":[{"minimum":1171.2,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1171.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1171.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1171.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAP RADICAL HYST","code_information":[{"code":"58548","type":"CPT"}],"standard_charges":[{"minimum":1982.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1982.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1982.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1982.63,"methodology":"fee schedule"}]}]},{"description":"LAPARO-ASST VAG HYSTERECTOMY","code_information":[{"code":"58550","type":"CPT"}],"standard_charges":[{"minimum":930.16,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":930.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":930.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":930.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPARO-VAG HYST INCL T/O","code_information":[{"code":"58552","type":"CPT"}],"standard_charges":[{"minimum":1032.8,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO-VAG HYST COMPLEX","code_information":[{"code":"58553","type":"CPT"}],"standard_charges":[{"minimum":1177.99,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO-VAG HYST W/T/O COMPL","code_information":[{"code":"58554","type":"CPT"}],"standard_charges":[{"minimum":1372.89,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1372.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1372.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1372.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPY DX SEP PROC","code_information":[{"code":"58555","type":"CPT"}],"standard_charges":[{"minimum":158.42,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPY BIOPSY","code_information":[{"code":"58558","type":"CPT"}],"standard_charges":[{"minimum":242.11,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPY LYSIS","code_information":[{"code":"58559","type":"CPT"}],"standard_charges":[{"minimum":296.82,"maximum":5419.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPY RESECT SEPTUM","code_information":[{"code":"58560","type":"CPT"}],"standard_charges":[{"minimum":326.86,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPY REMOVE MYOMA","code_information":[{"code":"58561","type":"CPT"}],"standard_charges":[{"minimum":374.07,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPY REMOVE FB","code_information":[{"code":"58562","type":"CPT"}],"standard_charges":[{"minimum":231.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPY ABLATION","code_information":[{"code":"58563","type":"CPT"}],"standard_charges":[{"minimum":257.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPY STERILIZATION","code_information":[{"code":"58565","type":"CPT"}],"standard_charges":[{"minimum":483.86,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"TLH UTERUS 250 G OR LESS","code_information":[{"code":"58570","type":"CPT"}],"standard_charges":[{"minimum":851.49,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"TLH W/T/O 250 G OR LESS","code_information":[{"code":"58571","type":"CPT"}],"standard_charges":[{"minimum":958.77,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3539.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2654.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2654.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"TLH UTERUS OVER 250 G","code_information":[{"code":"58572","type":"CPT"}],"standard_charges":[{"minimum":1068.56,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3949.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2962.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2962.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"TLH W/T/O UTERUS OVER 250 G","code_information":[{"code":"58573","type":"CPT"}],"standard_charges":[{"minimum":1283.49,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4472.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3355.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3355.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1283.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1283.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1283.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPS TOT HYST RESJ MAL","code_information":[{"code":"58575","type":"CPT"}],"standard_charges":[{"minimum":2034.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2034.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2034.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2034.84,"methodology":"fee schedule"}]}]},{"description":"LAPARO PROC UTERUS","code_information":[{"code":"58578","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"HYSTEROSCOPE PROCEDURE","code_information":[{"code":"58579","type":"CPT"}],"standard_charges":[{"minimum":126.57,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"DIVISION OF FALLOPIAN TUBE","code_information":[{"code":"58600","type":"CPT"}],"standard_charges":[{"minimum":392.31,"maximum":4392.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DIVISION OF FALLOPIAN TUBE","code_information":[{"code":"58605","type":"CPT"}],"standard_charges":[{"minimum":356.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.9,"methodology":"fee schedule"}]}]},{"description":"LIGATE OVIDUCT(S) ADD-ON","code_information":[{"code":"58611","type":"CPT"}],"standard_charges":[{"minimum":78.68,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.68,"methodology":"fee schedule"}]}]},{"description":"OCCLUDE FALLOPIAN TUBE(S)","code_information":[{"code":"58615","type":"CPT"}],"standard_charges":[{"minimum":268.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY LYSIS","code_information":[{"code":"58660","type":"CPT"}],"standard_charges":[{"minimum":720.6,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY REMOVE ADNEXA","code_information":[{"code":"58661","type":"CPT"}],"standard_charges":[{"minimum":686.98,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY EXCISE LESIONS","code_information":[{"code":"58662","type":"CPT"}],"standard_charges":[{"minimum":751.71,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY TUBAL CAUTERY","code_information":[{"code":"58670","type":"CPT"}],"standard_charges":[{"minimum":393.02,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY TUBAL BLOCK","code_information":[{"code":"58671","type":"CPT"}],"standard_charges":[{"minimum":393.02,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY FIMBRIOPLASTY","code_information":[{"code":"58672","type":"CPT"}],"standard_charges":[{"minimum":3295.22,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY SALPINGOSTOMY","code_information":[{"code":"58673","type":"CPT"}],"standard_charges":[{"minimum":3295.22,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPS ABLTJ UTERINE FIBROIDS","code_information":[{"code":"58674","type":"CPT"}],"standard_charges":[{"minimum":856.14,"maximum":11429.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3579.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2685.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2685.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11207.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11429.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11373.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11096.49,"methodology":"fee schedule"}]}]},{"description":"LAPARO PROC OVIDUCT-OVARY","code_information":[{"code":"58679","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FALLOPIAN TUBE","code_information":[{"code":"58700","type":"CPT"}],"standard_charges":[{"minimum":844.33,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.33,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF OVARY/TUBE(S)","code_information":[{"code":"58720","type":"CPT"}],"standard_charges":[{"minimum":802.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.13,"methodology":"fee schedule"}]}]},{"description":"ADHESIOLYSIS TUBE OVARY","code_information":[{"code":"58740","type":"CPT"}],"standard_charges":[{"minimum":949.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.83,"methodology":"fee schedule"}]}]},{"description":"CREATE NEW TUBAL OPENING","code_information":[{"code":"58770","type":"CPT"}],"standard_charges":[{"minimum":2788,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF OVARIAN CYST(S)","code_information":[{"code":"58800","type":"CPT"}],"standard_charges":[{"minimum":334.37,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF OVARIAN CYST(S)","code_information":[{"code":"58805","type":"CPT"}],"standard_charges":[{"minimum":453.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DRAIN OVARY ABSCESS OPEN","code_information":[{"code":"58820","type":"CPT"}],"standard_charges":[{"minimum":359.41,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DRAIN OVARY ABSCESS PERCUT","code_information":[{"code":"58822","type":"CPT"}],"standard_charges":[{"minimum":754.21,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.21,"methodology":"fee schedule"}]}]},{"description":"TRANSPOSITION OVARY(S)","code_information":[{"code":"58825","type":"CPT"}],"standard_charges":[{"minimum":748.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.85,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF OVARY(S)","code_information":[{"code":"58900","type":"CPT"}],"standard_charges":[{"minimum":463.11,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF OVARY(S)","code_information":[{"code":"58920","type":"CPT"}],"standard_charges":[{"minimum":753.86,"maximum":8117.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7960.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8117.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8039.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8078.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.54,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF OVARIAN CYST(S)","code_information":[{"code":"58925","type":"CPT"}],"standard_charges":[{"minimum":808.57,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":808.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":808.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":808.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF OVARY(S)","code_information":[{"code":"58940","type":"CPT"}],"standard_charges":[{"minimum":586.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.49,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF OVARY(S)","code_information":[{"code":"58943","type":"CPT"}],"standard_charges":[{"minimum":1266.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"}]}]},{"description":"RESECT OVARIAN MALIGNANCY","code_information":[{"code":"58950","type":"CPT"}],"standard_charges":[{"minimum":1213.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1213.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1213.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1213.75,"methodology":"fee schedule"}]}]},{"description":"RESECT OVARIAN MALIGNANCY","code_information":[{"code":"58951","type":"CPT"}],"standard_charges":[{"minimum":1519.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1519.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1519.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1519.51,"methodology":"fee schedule"}]}]},{"description":"RESECT OVARIAN MALIGNANCY","code_information":[{"code":"58952","type":"CPT"}],"standard_charges":[{"minimum":1736.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.23,"methodology":"fee schedule"}]}]},{"description":"TAH RAD DISSECT FOR DEBULK","code_information":[{"code":"58953","type":"CPT"}],"standard_charges":[{"minimum":2107.44,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2107.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2107.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2107.44,"methodology":"fee schedule"}]}]},{"description":"TAH RAD DEBULK/LYMPH REMOVE","code_information":[{"code":"58954","type":"CPT"}],"standard_charges":[{"minimum":2280.17,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2280.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2280.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2280.17,"methodology":"fee schedule"}]}]},{"description":"BSO OMENTECTOMY W/TAH","code_information":[{"code":"58956","type":"CPT"}],"standard_charges":[{"minimum":1434.4,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1434.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1434.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1434.4,"methodology":"fee schedule"}]}]},{"description":"RESECT RECURRENT GYN MAL","code_information":[{"code":"58957","type":"CPT"}],"standard_charges":[{"minimum":1675.44,"maximum":1675.44,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1675.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1675.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1675.44,"methodology":"fee schedule"}]}]},{"description":"RESECT RECUR GYN MAL W/LYM","code_information":[{"code":"58958","type":"CPT"}],"standard_charges":[{"minimum":1741.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1741.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1741.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1741.59,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF ABDOMEN","code_information":[{"code":"58960","type":"CPT"}],"standard_charges":[{"minimum":1052.82,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.82,"methodology":"fee schedule"}]}]},{"description":"RETRIEVAL OF OOCYTE","code_information":[{"code":"58970","type":"CPT"}],"standard_charges":[{"minimum":928.05,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"TRANSFER OF EMBRYO","code_information":[{"code":"58974","type":"CPT"}],"standard_charges":[{"minimum":588.03,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"TRANSFER OF EMBRYO","code_information":[{"code":"58976","type":"CPT"}],"standard_charges":[{"minimum":324.21,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"GENITAL SURGERY PROCEDURE","code_information":[{"code":"58999","type":"CPT"}],"standard_charges":[{"minimum":126.57,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"AMNIOCENTESIS DIAGNOSTIC","code_information":[{"code":"59000","type":"CPT"}],"standard_charges":[{"minimum":82.93,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"AMNIOCENTESIS THERAPEUTIC","code_information":[{"code":"59001","type":"CPT"}],"standard_charges":[{"minimum":182.79,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1603.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1202.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1202.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"FETAL CORD PUNCTURE PRENATAL","code_information":[{"code":"59012","type":"CPT"}],"standard_charges":[{"minimum":206.79,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"CHORION BIOPSY","code_information":[{"code":"59015","type":"CPT"}],"standard_charges":[{"minimum":134.8,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":937.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":955.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":951.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":928.05,"methodology":"fee schedule"}]}]},{"description":"FETAL CONTRACT STRESS TEST","code_information":[{"code":"59020","type":"CPT"}],"standard_charges":[{"minimum":73.75,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"FETAL NON-STRESS TEST","code_information":[{"code":"59025","type":"CPT"}],"standard_charges":[{"minimum":50.81,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"FETAL SCALP BLOOD SAMPLE","code_information":[{"code":"59030","type":"CPT"}],"standard_charges":[{"minimum":114.69,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"FETAL MONITOR W/REPORT","code_information":[{"code":"59050","type":"CPT"}],"standard_charges":[{"minimum":50.81,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"}]}]},{"description":"FETAL MONITOR/INTERPRET ONLY","code_information":[{"code":"59051","type":"CPT"}],"standard_charges":[{"minimum":43.05,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":180.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":180.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.05,"methodology":"fee schedule"}]}]},{"description":"TRANSABDOM AMNIOINFUS W/US","code_information":[{"code":"59070","type":"CPT"}],"standard_charges":[{"minimum":316.53,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"UMBILICAL CORD OCCLUD W/US","code_information":[{"code":"59072","type":"CPT"}],"standard_charges":[{"minimum":324.21,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"FETAL FLUID DRAINAGE W/US","code_information":[{"code":"59074","type":"CPT"}],"standard_charges":[{"minimum":316.53,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"FETAL SHUNT PLACEMENT W/US","code_information":[{"code":"59076","type":"CPT"}],"standard_charges":[{"minimum":324.21,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"REMOVE UTERUS LESION","code_information":[{"code":"59100","type":"CPT"}],"standard_charges":[{"minimum":887.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":887.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":887.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":887.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5313.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5419.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5366.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5392.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5261.37,"methodology":"fee schedule"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59120","type":"CPT"}],"standard_charges":[{"minimum":846.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.56,"methodology":"fee schedule"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59121","type":"CPT"}],"standard_charges":[{"minimum":846.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.91,"methodology":"fee schedule"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59130","type":"CPT"}],"standard_charges":[{"minimum":982.07,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.07,"methodology":"fee schedule"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59136","type":"CPT"}],"standard_charges":[{"minimum":931.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.96,"methodology":"fee schedule"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59140","type":"CPT"}],"standard_charges":[{"minimum":434.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.04,"methodology":"fee schedule"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59150","type":"CPT"}],"standard_charges":[{"minimum":821.15,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59151","type":"CPT"}],"standard_charges":[{"minimum":803.51,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"D  C AFTER DELIVERY","code_information":[{"code":"59160","type":"CPT"}],"standard_charges":[{"minimum":195.5,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"INSERT CERVICAL DILATOR","code_information":[{"code":"59200","type":"CPT"}],"standard_charges":[{"minimum":45.52,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":588.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"EPISIOTOMY OR VAGINAL REPAIR","code_information":[{"code":"59300","type":"CPT"}],"standard_charges":[{"minimum":152.09,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CERVIX","code_information":[{"code":"59320","type":"CPT"}],"standard_charges":[{"minimum":155.97,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CERVIX","code_information":[{"code":"59325","type":"CPT"}],"standard_charges":[{"minimum":247.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.02,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF UTERUS","code_information":[{"code":"59350","type":"CPT"}],"standard_charges":[{"minimum":285.48,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.48,"methodology":"fee schedule"}]}]},{"description":"OBSTETRICAL CARE","code_information":[{"code":"59400","type":"CPT"}],"standard_charges":[{"minimum":3811.89,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3811.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3811.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3811.89,"methodology":"fee schedule"}]}]},{"description":"OBSTETRICAL CARE","code_information":[{"code":"59409","type":"CPT"}],"standard_charges":[{"minimum":942.5,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":942.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":942.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":942.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"OBSTETRICAL CARE","code_information":[{"code":"59410","type":"CPT"}],"standard_charges":[{"minimum":1275.82,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.82,"methodology":"fee schedule"}]}]},{"description":"ANTEPARTUM MANIPULATION","code_information":[{"code":"59412","type":"CPT"}],"standard_charges":[{"minimum":105.51,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"DELIVER PLACENTA","code_information":[{"code":"59414","type":"CPT"}],"standard_charges":[{"minimum":92.81,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"ANTEPARTUM CARE ONLY","code_information":[{"code":"59425","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":445.69,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.69,"methodology":"fee schedule"}]}]},{"description":"ANTEPARTUM CARE ONLY","code_information":[{"code":"59426","type":"CPT"}],"standard_charges":[{"minimum":293.63,"maximum":818.33,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.33,"methodology":"fee schedule"}]}]},{"description":"CARE AFTER DELIVERY","code_information":[{"code":"59430","type":"CPT"}],"standard_charges":[{"minimum":184.56,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.56,"methodology":"fee schedule"}]}]},{"description":"CESAREAN DELIVERY","code_information":[{"code":"59510","type":"CPT"}],"standard_charges":[{"minimum":4204.21,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4204.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4204.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4204.21,"methodology":"fee schedule"}]}]},{"description":"CESAREAN DELIVERY ONLY","code_information":[{"code":"59514","type":"CPT"}],"standard_charges":[{"minimum":1066.69,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.69,"methodology":"fee schedule"}]}]},{"description":"CESAREAN DELIVERY","code_information":[{"code":"59515","type":"CPT"}],"standard_charges":[{"minimum":1581.63,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE UTERUS AFTER CESAREAN","code_information":[{"code":"59525","type":"CPT"}],"standard_charges":[{"minimum":493.33,"maximum":3048.53,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.33,"methodology":"fee schedule"}]}]},{"description":"VBAC DELIVERY","code_information":[{"code":"59610","type":"CPT"}],"standard_charges":[{"minimum":3981.05,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3981.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3981.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3981.05,"methodology":"fee schedule"}]}]},{"description":"VBAC DELIVERY ONLY","code_information":[{"code":"59612","type":"CPT"}],"standard_charges":[{"minimum":1065.47,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1065.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1065.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1065.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"VBAC CARE AFTER DELIVERY","code_information":[{"code":"59614","type":"CPT"}],"standard_charges":[{"minimum":1376.14,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1376.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1376.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1376.14,"methodology":"fee schedule"}]}]},{"description":"ATTEMPTED VBAC DELIVERY","code_information":[{"code":"59618","type":"CPT"}],"standard_charges":[{"minimum":4248.16,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4248.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4248.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4248.16,"methodology":"fee schedule"}]}]},{"description":"ATTEMPTED VBAC DELIVERY ONLY","code_information":[{"code":"59620","type":"CPT"}],"standard_charges":[{"minimum":1103.5,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.5,"methodology":"fee schedule"}]}]},{"description":"ATTEMPTED VBAC AFTER CARE","code_information":[{"code":"59622","type":"CPT"}],"standard_charges":[{"minimum":1639.07,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1639.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1639.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1639.07,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF MISCARRIAGE","code_information":[{"code":"59812","type":"CPT"}],"standard_charges":[{"minimum":319.71,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"CARE OF MISCARRIAGE","code_information":[{"code":"59820","type":"CPT"}],"standard_charges":[{"minimum":402.99,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF MISCARRIAGE","code_information":[{"code":"59821","type":"CPT"}],"standard_charges":[{"minimum":393.46,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"TREAT UTERUS INFECTION","code_information":[{"code":"59830","type":"CPT"}],"standard_charges":[{"minimum":482.74,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.74,"methodology":"fee schedule"}]}]},{"description":"ABORTION","code_information":[{"code":"59840","type":"CPT"}],"standard_charges":[{"minimum":231.14,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"ABORTION","code_information":[{"code":"59841","type":"CPT"}],"standard_charges":[{"minimum":386.76,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"ABORTION","code_information":[{"code":"59850","type":"CPT"}],"standard_charges":[{"minimum":406.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"}]}]},{"description":"ABORTION","code_information":[{"code":"59851","type":"CPT"}],"standard_charges":[{"minimum":445.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.69,"methodology":"fee schedule"}]}]},{"description":"ABORTION","code_information":[{"code":"59852","type":"CPT"}],"standard_charges":[{"minimum":612.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.25,"methodology":"fee schedule"}]}]},{"description":"ABORTION","code_information":[{"code":"59855","type":"CPT"}],"standard_charges":[{"minimum":441.81,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.81,"methodology":"fee schedule"}]}]},{"description":"ABORTION","code_information":[{"code":"59856","type":"CPT"}],"standard_charges":[{"minimum":516.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.26,"methodology":"fee schedule"}]}]},{"description":"ABORTION","code_information":[{"code":"59857","type":"CPT"}],"standard_charges":[{"minimum":600.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"}]}]},{"description":"ABORTION (MPR)","code_information":[{"code":"59866","type":"CPT"}],"standard_charges":[{"minimum":324.21,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.21,"methodology":"fee schedule"}]}]},{"description":"EVACUATE MOLE OF UTERUS","code_information":[{"code":"59870","type":"CPT"}],"standard_charges":[{"minimum":558.61,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE CERCLAGE SUTURE","code_information":[{"code":"59871","type":"CPT"}],"standard_charges":[{"minimum":137.27,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3422.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3490.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3473.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3388.81,"methodology":"fee schedule"}]}]},{"description":"FETAL INVAS PX W/US","code_information":[{"code":"59897","type":"CPT"}],"standard_charges":[{"minimum":126.57,"maximum":3760.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3760.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2820.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2820.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"LAPARO PROC OB CARE/DELIVER","code_information":[{"code":"59898","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":9876.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9876.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7408.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7408.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"MATERNITY CARE PROCEDURE","code_information":[{"code":"59899","type":"CPT"}],"standard_charges":[{"minimum":126.57,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":216.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":220.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"fee schedule"}]}]},{"description":"DRAIN THYROID/TONGUE CYST","code_information":[{"code":"60000","type":"CPT"}],"standard_charges":[{"minimum":167.72,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF THYROID","code_information":[{"code":"60100","type":"CPT"}],"standard_charges":[{"minimum":79.39,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"REMOVE THYROID LESION","code_information":[{"code":"60200","type":"CPT"}],"standard_charges":[{"minimum":704.86,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PARTIAL THYROID EXCISION","code_information":[{"code":"60210","type":"CPT"}],"standard_charges":[{"minimum":743.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PARTIAL THYROID EXCISION","code_information":[{"code":"60212","type":"CPT"}],"standard_charges":[{"minimum":1072.85,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF THYROID","code_information":[{"code":"60220","type":"CPT"}],"standard_charges":[{"minimum":743.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF THYROID","code_information":[{"code":"60225","type":"CPT"}],"standard_charges":[{"minimum":986.31,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":986.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF THYROID","code_information":[{"code":"60240","type":"CPT"}],"standard_charges":[{"minimum":962.35,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF THYROID","code_information":[{"code":"60252","type":"CPT"}],"standard_charges":[{"minimum":1382.9,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1382.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE THYROID SURGERY","code_information":[{"code":"60254","type":"CPT"}],"standard_charges":[{"minimum":1745.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1745.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1745.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1745.53,"methodology":"fee schedule"}]}]},{"description":"REPEAT THYROID SURGERY","code_information":[{"code":"60260","type":"CPT"}],"standard_charges":[{"minimum":1141.16,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF THYROID","code_information":[{"code":"60270","type":"CPT"}],"standard_charges":[{"minimum":1425.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1425.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1425.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1425.82,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF THYROID","code_information":[{"code":"60271","type":"CPT"}],"standard_charges":[{"minimum":1105.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE THYROID DUCT LESION","code_information":[{"code":"60280","type":"CPT"}],"standard_charges":[{"minimum":481.71,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE THYROID DUCT LESION","code_information":[{"code":"60281","type":"CPT"}],"standard_charges":[{"minimum":630.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"ASPIR/INJ THYROID CYST","code_information":[{"code":"60300","type":"CPT"}],"standard_charges":[{"minimum":50.42,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":876.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"EXPLORE PARATHYROID GLANDS","code_information":[{"code":"60500","type":"CPT"}],"standard_charges":[{"minimum":1017.42,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RE-EXPLORE PARATHYROIDS","code_information":[{"code":"60502","type":"CPT"}],"standard_charges":[{"minimum":1364.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1364.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1364.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1364.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXPLORE PARATHYROID GLANDS","code_information":[{"code":"60505","type":"CPT"}],"standard_charges":[{"minimum":1468.73,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1468.73,"methodology":"fee schedule"}]}]},{"description":"AUTOTRANSPLANT PARATHYROID","code_information":[{"code":"60512","type":"CPT"}],"standard_charges":[{"minimum":250.69,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF THYMUS GLAND","code_information":[{"code":"60520","type":"CPT"}],"standard_charges":[{"minimum":1096.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1096.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1096.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1096.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF THYMUS GLAND","code_information":[{"code":"60521","type":"CPT"}],"standard_charges":[{"minimum":1162.97,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.97,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF THYMUS GLAND","code_information":[{"code":"60522","type":"CPT"}],"standard_charges":[{"minimum":1406.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.87,"methodology":"fee schedule"}]}]},{"description":"EXPLORE ADRENAL GLAND","code_information":[{"code":"60540","type":"CPT"}],"standard_charges":[{"minimum":1128.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.28,"methodology":"fee schedule"}]}]},{"description":"EXPLORE ADRENAL GLAND","code_information":[{"code":"60545","type":"CPT"}],"standard_charges":[{"minimum":1306.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1306.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1306.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1306.02,"methodology":"fee schedule"}]}]},{"description":"REMOVE CAROTID BODY LESION","code_information":[{"code":"60600","type":"CPT"}],"standard_charges":[{"minimum":1414.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1414.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1414.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1414.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE CAROTID BODY LESION","code_information":[{"code":"60605","type":"CPT"}],"standard_charges":[{"minimum":1679.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY ADRENALECTOMY","code_information":[{"code":"60650","type":"CPT"}],"standard_charges":[{"minimum":1243.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.43,"methodology":"fee schedule"}]}]},{"description":"LAPARO PROC ENDOCRINE","code_information":[{"code":"60659","type":"CPT"}],"standard_charges":[{"minimum":3239,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"ENDOCRINE SURGERY PROCEDURE","code_information":[{"code":"60699","type":"CPT"}],"standard_charges":[{"minimum":1530.45,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3760.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6280.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6404.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6342.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6373.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6218.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE CRANIAL CAVITY FLUID","code_information":[{"code":"61000","type":"CPT"}],"standard_charges":[{"minimum":118.73,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"REMOVE CRANIAL CAVITY FLUID","code_information":[{"code":"61001","type":"CPT"}],"standard_charges":[{"minimum":112.65,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"REMOVE BRAIN CAVITY FLUID","code_information":[{"code":"61020","type":"CPT"}],"standard_charges":[{"minimum":111.93,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INJECTION INTO BRAIN CANAL","code_information":[{"code":"61026","type":"CPT"}],"standard_charges":[{"minimum":114.8,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"REMOVE BRAIN CANAL FLUID","code_information":[{"code":"61050","type":"CPT"}],"standard_charges":[{"minimum":83.32,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"INJECTION INTO BRAIN CANAL","code_information":[{"code":"61055","type":"CPT"}],"standard_charges":[{"minimum":121.95,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"BRAIN CANAL SHUNT PROCEDURE","code_information":[{"code":"61070","type":"CPT"}],"standard_charges":[{"minimum":58.65,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"TWIST DRILL HOLE","code_information":[{"code":"61105","type":"CPT"}],"standard_charges":[{"minimum":493.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.51,"methodology":"fee schedule"}]}]},{"description":"DRILL SKULL FOR IMPLANTATION","code_information":[{"code":"61107","type":"CPT"}],"standard_charges":[{"minimum":323.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.64,"methodology":"fee schedule"}]}]},{"description":"DRILL SKULL FOR DRAINAGE","code_information":[{"code":"61108","type":"CPT"}],"standard_charges":[{"minimum":957.7,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.7,"methodology":"fee schedule"}]}]},{"description":"BURR HOLE FOR PUNCTURE","code_information":[{"code":"61120","type":"CPT"}],"standard_charges":[{"minimum":794.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.27,"methodology":"fee schedule"}]}]},{"description":"PIERCE SKULL FOR BIOPSY","code_information":[{"code":"61140","type":"CPT"}],"standard_charges":[{"minimum":1341.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.42,"methodology":"fee schedule"}]}]},{"description":"PIERCE SKULL FOR DRAINAGE","code_information":[{"code":"61150","type":"CPT"}],"standard_charges":[{"minimum":1420.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.45,"methodology":"fee schedule"}]}]},{"description":"PIERCE SKULL FOR DRAINAGE","code_information":[{"code":"61151","type":"CPT"}],"standard_charges":[{"minimum":1048.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"}]}]},{"description":"PIERCE SKULL  REMOVE CLOT","code_information":[{"code":"61154","type":"CPT"}],"standard_charges":[{"minimum":1348.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.22,"methodology":"fee schedule"}]}]},{"description":"PIERCE SKULL FOR DRAINAGE","code_information":[{"code":"61156","type":"CPT"}],"standard_charges":[{"minimum":1304.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1304.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1304.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1304.23,"methodology":"fee schedule"}]}]},{"description":"PIERCE SKULL IMPLANT DEVICE","code_information":[{"code":"61210","type":"CPT"}],"standard_charges":[{"minimum":379.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.43,"methodology":"fee schedule"}]}]},{"description":"INSERT BRAIN-FLUID DEVICE","code_information":[{"code":"61215","type":"CPT"}],"standard_charges":[{"minimum":549.3,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"PIERCE SKULL  EXPLORE","code_information":[{"code":"61250","type":"CPT"}],"standard_charges":[{"minimum":917.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.29,"methodology":"fee schedule"}]}]},{"description":"PIERCE SKULL  EXPLORE","code_information":[{"code":"61253","type":"CPT"}],"standard_charges":[{"minimum":1048.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.18,"methodology":"fee schedule"}]}]},{"description":"OPEN SKULL FOR EXPLORATION","code_information":[{"code":"61304","type":"CPT"}],"standard_charges":[{"minimum":1722.64,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1722.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1722.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1722.64,"methodology":"fee schedule"}]}]},{"description":"OPEN SKULL FOR EXPLORATION","code_information":[{"code":"61305","type":"CPT"}],"standard_charges":[{"minimum":2104.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2104.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2104.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2104.22,"methodology":"fee schedule"}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61312","type":"CPT"}],"standard_charges":[{"minimum":2169.3,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2169.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2169.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2169.3,"methodology":"fee schedule"}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61313","type":"CPT"}],"standard_charges":[{"minimum":2084.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2084.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2084.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2084.91,"methodology":"fee schedule"}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61314","type":"CPT"}],"standard_charges":[{"minimum":1916.83,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1916.83,"methodology":"fee schedule"}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61315","type":"CPT"}],"standard_charges":[{"minimum":2170.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2170.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2170.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2170.74,"methodology":"fee schedule"}]}]},{"description":"IMPLT CRAN BONE FLAP TO ABDO","code_information":[{"code":"61316","type":"CPT"}],"standard_charges":[{"minimum":90.48,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61320","type":"CPT"}],"standard_charges":[{"minimum":1985.49,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1985.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1985.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1985.49,"methodology":"fee schedule"}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61321","type":"CPT"}],"standard_charges":[{"minimum":2227.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2227.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2227.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2227.6,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSIVE CRANIOTOMY","code_information":[{"code":"61322","type":"CPT"}],"standard_charges":[{"minimum":2497.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2497.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2497.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2497.95,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESSIVE LOBECTOMY","code_information":[{"code":"61323","type":"CPT"}],"standard_charges":[{"minimum":2503.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2503.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2503.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2503.32,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS EYE SOCKET","code_information":[{"code":"61330","type":"CPT"}],"standard_charges":[{"minimum":1885,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EXPLORE ORBIT/REMOVE LESION","code_information":[{"code":"61333","type":"CPT"}],"standard_charges":[{"minimum":2113.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2113.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2113.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2113.16,"methodology":"fee schedule"}]}]},{"description":"SUBTEMPORAL DECOMPRESSION","code_information":[{"code":"61340","type":"CPT"}],"standard_charges":[{"minimum":1514.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1514.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1514.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1514.87,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL (PRESS RELIEF)","code_information":[{"code":"61343","type":"CPT"}],"standard_charges":[{"minimum":2297.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2297.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2297.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2297.69,"methodology":"fee schedule"}]}]},{"description":"RELIEVE CRANIAL PRESSURE","code_information":[{"code":"61345","type":"CPT"}],"standard_charges":[{"minimum":2142.84,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2142.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2142.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2142.84,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL FOR SURGERY","code_information":[{"code":"61450","type":"CPT"}],"standard_charges":[{"minimum":2013.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013.38,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL FOR BRAIN WOUND","code_information":[{"code":"61458","type":"CPT"}],"standard_charges":[{"minimum":2109.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2109.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2109.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2109.58,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL FOR SURGERY","code_information":[{"code":"61460","type":"CPT"}],"standard_charges":[{"minimum":2209,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2209,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2209,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2209,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SKULL LESION","code_information":[{"code":"61500","type":"CPT"}],"standard_charges":[{"minimum":1367.17,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5814,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1367.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1367.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1367.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE INFECTED SKULL BONE","code_information":[{"code":"61501","type":"CPT"}],"standard_charges":[{"minimum":1190.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1190.86,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61510","type":"CPT"}],"standard_charges":[{"minimum":2312.35,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2312.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2312.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2312.35,"methodology":"fee schedule"}]}]},{"description":"REMOVE BRAIN LINING LESION","code_information":[{"code":"61512","type":"CPT"}],"standard_charges":[{"minimum":2672.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2672.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2672.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2672.47,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN ABSCESS","code_information":[{"code":"61514","type":"CPT"}],"standard_charges":[{"minimum":2009.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2009.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2009.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2009.09,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61516","type":"CPT"}],"standard_charges":[{"minimum":1968.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1968.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1968.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1968.32,"methodology":"fee schedule"}]}]},{"description":"IMPLT BRAIN CHEMOTX ADD-ON","code_information":[{"code":"61517","type":"CPT"}],"standard_charges":[{"minimum":90.12,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.12,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61518","type":"CPT"}],"standard_charges":[{"minimum":2902.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2902.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2902.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2902.42,"methodology":"fee schedule"}]}]},{"description":"REMOVE BRAIN LINING LESION","code_information":[{"code":"61519","type":"CPT"}],"standard_charges":[{"minimum":3075.86,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3075.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3075.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3075.86,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61520","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3884.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3884.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3884.08,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61521","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3321.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3321.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3321.19,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN ABSCESS","code_information":[{"code":"61522","type":"CPT"}],"standard_charges":[{"minimum":2293.4,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2293.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2293.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2293.4,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61524","type":"CPT"}],"standard_charges":[{"minimum":2186.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2186.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2186.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2186.11,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61526","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3490.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3490.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3490.7,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61530","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3208.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3208.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3208.18,"methodology":"fee schedule"}]}]},{"description":"IMPLANT BRAIN ELECTRODES","code_information":[{"code":"61531","type":"CPT"}],"standard_charges":[{"minimum":1294.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.57,"methodology":"fee schedule"}]}]},{"description":"IMPLANT BRAIN ELECTRODES","code_information":[{"code":"61533","type":"CPT"}],"standard_charges":[{"minimum":1606.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1606.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1606.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1606.06,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61534","type":"CPT"}],"standard_charges":[{"minimum":1736.95,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.95,"methodology":"fee schedule"}]}]},{"description":"REMOVE BRAIN ELECTRODES","code_information":[{"code":"61535","type":"CPT"}],"standard_charges":[{"minimum":1064.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.27,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61536","type":"CPT"}],"standard_charges":[{"minimum":2696.43,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2696.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2696.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2696.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61537","type":"CPT"}],"standard_charges":[{"minimum":2568.05,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2568.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2568.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2568.05,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61538","type":"CPT"}],"standard_charges":[{"minimum":2779.76,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2779.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2779.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2779.76,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61539","type":"CPT"}],"standard_charges":[{"minimum":2471.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2471.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2471.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2471.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61540","type":"CPT"}],"standard_charges":[{"minimum":2281.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2281.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2281.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2281.24,"methodology":"fee schedule"}]}]},{"description":"INCISION OF BRAIN TISSUE","code_information":[{"code":"61541","type":"CPT"}],"standard_charges":[{"minimum":2254.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2254.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2254.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2254.42,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61543","type":"CPT"}],"standard_charges":[{"minimum":2278.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2278.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2278.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2278.74,"methodology":"fee schedule"}]}]},{"description":"REMOVE  TREAT BRAIN LESION","code_information":[{"code":"61544","type":"CPT"}],"standard_charges":[{"minimum":1991.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1991.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1991.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1991.57,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF BRAIN TUMOR","code_information":[{"code":"61545","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3333.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3333.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3333.35,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PITUITARY GLAND","code_information":[{"code":"61546","type":"CPT"}],"standard_charges":[{"minimum":2417.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2417.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2417.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2417.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF PITUITARY GLAND","code_information":[{"code":"61548","type":"CPT"}],"standard_charges":[{"minimum":1646.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1646.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1646.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1646.11,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF SKULL SEAMS","code_information":[{"code":"61550","type":"CPT"}],"standard_charges":[{"minimum":1266.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1266.32,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF SKULL SEAMS","code_information":[{"code":"61552","type":"CPT"}],"standard_charges":[{"minimum":1566.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566.36,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL/SUTURES","code_information":[{"code":"61556","type":"CPT"}],"standard_charges":[{"minimum":1795.59,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1795.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1795.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1795.59,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL/SUTURES","code_information":[{"code":"61557","type":"CPT"}],"standard_charges":[{"minimum":1775.93,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1775.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1775.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1775.93,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF SKULL/SUTURES","code_information":[{"code":"61558","type":"CPT"}],"standard_charges":[{"minimum":1978.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1978.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1978.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1978.69,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF SKULL/SUTURES","code_information":[{"code":"61559","type":"CPT"}],"standard_charges":[{"minimum":2517.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2517.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2517.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2517.27,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF SKULL TUMOR","code_information":[{"code":"61563","type":"CPT"}],"standard_charges":[{"minimum":2079.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2079.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2079.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2079.9,"methodology":"fee schedule"}]}]},{"description":"EXCISION OF SKULL TUMOR","code_information":[{"code":"61564","type":"CPT"}],"standard_charges":[{"minimum":2521.56,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2521.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2521.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2521.56,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61566","type":"CPT"}],"standard_charges":[{"minimum":2347.4,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2347.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2347.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2347.4,"methodology":"fee schedule"}]}]},{"description":"INCISION OF BRAIN TISSUE","code_information":[{"code":"61567","type":"CPT"}],"standard_charges":[{"minimum":2673.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2673.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2673.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2673.54,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY BRAIN","code_information":[{"code":"61570","type":"CPT"}],"standard_charges":[{"minimum":1966.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.18,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL FOR BRAIN WOUND","code_information":[{"code":"61571","type":"CPT"}],"standard_charges":[{"minimum":2090.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2090.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2090.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2090.27,"methodology":"fee schedule"}]}]},{"description":"SKULL BASE/BRAINSTEM SURGERY","code_information":[{"code":"61575","type":"CPT"}],"standard_charges":[{"minimum":2620.97,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2620.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2620.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2620.97,"methodology":"fee schedule"}]}]},{"description":"SKULL BASE/BRAINSTEM SURGERY","code_information":[{"code":"61576","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4361.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4361.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4361.14,"methodology":"fee schedule"}]}]},{"description":"CRANIOFACIAL APPROACH SKULL","code_information":[{"code":"61580","type":"CPT"}],"standard_charges":[{"minimum":2606.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2606.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2606.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2606.67,"methodology":"fee schedule"}]}]},{"description":"CRANIOFACIAL APPROACH SKULL","code_information":[{"code":"61581","type":"CPT"}],"standard_charges":[{"minimum":2850.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2850.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2850.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2850.92,"methodology":"fee schedule"}]}]},{"description":"CRANIOFACIAL APPROACH SKULL","code_information":[{"code":"61582","type":"CPT"}],"standard_charges":[{"minimum":3145.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145.6,"methodology":"fee schedule"}]}]},{"description":"CRANIOFACIAL APPROACH SKULL","code_information":[{"code":"61583","type":"CPT"}],"standard_charges":[{"minimum":3054.41,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3054.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3054.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3054.41,"methodology":"fee schedule"}]}]},{"description":"ORBITOCRANIAL APPROACH/SKULL","code_information":[{"code":"61584","type":"CPT"}],"standard_charges":[{"minimum":3011.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3011.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3011.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3011.85,"methodology":"fee schedule"}]}]},{"description":"ORBITOCRANIAL APPROACH/SKULL","code_information":[{"code":"61585","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3427.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3427.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3427.4,"methodology":"fee schedule"}]}]},{"description":"RESECT NASOPHARYNX SKULL","code_information":[{"code":"61586","type":"CPT"}],"standard_charges":[{"minimum":2652.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2652.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2652.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2652.45,"methodology":"fee schedule"}]}]},{"description":"INFRATEMPORAL APPROACH/SKULL","code_information":[{"code":"61590","type":"CPT"}],"standard_charges":[{"minimum":3165.98,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3165.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3165.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3165.98,"methodology":"fee schedule"}]}]},{"description":"INFRATEMPORAL APPROACH/SKULL","code_information":[{"code":"61591","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3217.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3217.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3217.48,"methodology":"fee schedule"}]}]},{"description":"ORBITOCRANIAL APPROACH/SKULL","code_information":[{"code":"61592","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3315.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3315.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3315.82,"methodology":"fee schedule"}]}]},{"description":"TRANSTEMPORAL APPROACH/SKULL","code_information":[{"code":"61595","type":"CPT"}],"standard_charges":[{"minimum":2508.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2508.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2508.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2508.68,"methodology":"fee schedule"}]}]},{"description":"TRANSCOCHLEAR APPROACH/SKULL","code_information":[{"code":"61596","type":"CPT"}],"standard_charges":[{"minimum":2559.11,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2559.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2559.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2559.11,"methodology":"fee schedule"}]}]},{"description":"TRANSCONDYLAR APPROACH/SKULL","code_information":[{"code":"61597","type":"CPT"}],"standard_charges":[{"minimum":3101.25,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3101.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3101.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3101.25,"methodology":"fee schedule"}]}]},{"description":"TRANSPETROSAL APPROACH/SKULL","code_information":[{"code":"61598","type":"CPT"}],"standard_charges":[{"minimum":2985.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2985.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2985.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2985.39,"methodology":"fee schedule"}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61600","type":"CPT"}],"standard_charges":[{"minimum":2226.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2226.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2226.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2226.88,"methodology":"fee schedule"}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61601","type":"CPT"}],"standard_charges":[{"minimum":2548.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2548.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2548.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2548.38,"methodology":"fee schedule"}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61605","type":"CPT"}],"standard_charges":[{"minimum":2274.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2274.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2274.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2274.8,"methodology":"fee schedule"}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61606","type":"CPT"}],"standard_charges":[{"minimum":3038.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3038.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3038.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3038.67,"methodology":"fee schedule"}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61607","type":"CPT"}],"standard_charges":[{"minimum":3175.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3175.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3175.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3175.28,"methodology":"fee schedule"}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61608","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3427.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3427.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3427.04,"methodology":"fee schedule"}]}]},{"description":"TRANSECT ARTERY SINUS","code_information":[{"code":"61611","type":"CPT"}],"standard_charges":[{"minimum":482.78,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"}]}]},{"description":"REMOVE ANEURYSM SINUS","code_information":[{"code":"61613","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3432.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3432.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3432.05,"methodology":"fee schedule"}]}]},{"description":"RESECT/EXCISE LESION SKULL","code_information":[{"code":"61615","type":"CPT"}],"standard_charges":[{"minimum":2945.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2945.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2945.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2945.69,"methodology":"fee schedule"}]}]},{"description":"RESECT/EXCISE LESION SKULL","code_information":[{"code":"61616","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3494.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3494.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3494.28,"methodology":"fee schedule"}]}]},{"description":"REPAIR DURA","code_information":[{"code":"61618","type":"CPT"}],"standard_charges":[{"minimum":1352.15,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1352.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1352.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1352.15,"methodology":"fee schedule"}]}]},{"description":"REPAIR DURA","code_information":[{"code":"61619","type":"CPT"}],"standard_charges":[{"minimum":1504.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1504.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1504.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1504.14,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC TEMPORY VESSEL OCCL","code_information":[{"code":"61623","type":"CPT"}],"standard_charges":[{"minimum":596.86,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"TRANSCATH OCCLUSION CNS","code_information":[{"code":"61624","type":"CPT"}],"standard_charges":[{"minimum":1203.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.02,"methodology":"fee schedule"}]}]},{"description":"TRANSCATH OCCLUSION NON-CNS","code_information":[{"code":"61626","type":"CPT"}],"standard_charges":[{"minimum":936.96,"maximum":12449.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12207.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12449.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12328.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12389.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12087.01,"methodology":"fee schedule"}]}]},{"description":"INTRACRAN ANGIOPLSTY W/STENT","code_information":[{"code":"61635","type":"CPT"}],"standard_charges":[{"minimum":2595,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERQ ART M-THROMBECT /NFS","code_information":[{"code":"61645","type":"CPT"}],"standard_charges":[{"minimum":872.94,"maximum":5223,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":872.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":872.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":872.94,"methodology":"fee schedule"}]}]},{"description":"EVASC PRLNG ADMN RX AGNT 1ST","code_information":[{"code":"61650","type":"CPT"}],"standard_charges":[{"minimum":602.58,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.58,"methodology":"fee schedule"}]}]},{"description":"EVASC PRLNG ADMN RX AGNT ADD","code_information":[{"code":"61651","type":"CPT"}],"standard_charges":[{"minimum":257.13,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.13,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61680","type":"CPT"}],"standard_charges":[{"minimum":2378.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2378.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2378.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2378.87,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61682","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4342.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4342.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4342.19,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61684","type":"CPT"}],"standard_charges":[{"minimum":2971.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2971.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2971.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2971.8,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61686","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4676.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4676.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4676.56,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61690","type":"CPT"}],"standard_charges":[{"minimum":2287.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2287.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2287.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2287.68,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61692","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3803.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3803.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3803.26,"methodology":"fee schedule"}]}]},{"description":"BRAIN ANEURYSM REPR COMPLX","code_information":[{"code":"61697","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4401.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4401.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4401.19,"methodology":"fee schedule"}]}]},{"description":"BRAIN ANEURYSM REPR COMPLX","code_information":[{"code":"61698","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815.31,"methodology":"fee schedule"}]}]},{"description":"BRAIN ANEURYSM REPR SIMPLE","code_information":[{"code":"61700","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3561.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3561.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3561.87,"methodology":"fee schedule"}]}]},{"description":"INNER SKULL VESSEL SURGERY","code_information":[{"code":"61702","type":"CPT"}],"standard_charges":[{"minimum":3193,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4189.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4189.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4189.48,"methodology":"fee schedule"}]}]},{"description":"CLAMP NECK ARTERY","code_information":[{"code":"61703","type":"CPT"}],"standard_charges":[{"minimum":1432.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1432.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1432.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1432.26,"methodology":"fee schedule"}]}]},{"description":"REVISE CIRCULATION TO HEAD","code_information":[{"code":"61705","type":"CPT"}],"standard_charges":[{"minimum":2721.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2721.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2721.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2721.47,"methodology":"fee schedule"}]}]},{"description":"REVISE CIRCULATION TO HEAD","code_information":[{"code":"61708","type":"CPT"}],"standard_charges":[{"minimum":2663.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2663.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2663.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2663.53,"methodology":"fee schedule"}]}]},{"description":"REVISE CIRCULATION TO HEAD","code_information":[{"code":"61710","type":"CPT"}],"standard_charges":[{"minimum":2247.27,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2247.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2247.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2247.27,"methodology":"fee schedule"}]}]},{"description":"FUSION OF SKULL ARTERIES","code_information":[{"code":"61711","type":"CPT"}],"standard_charges":[{"minimum":2727.19,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2727.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2727.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2727.19,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL/BRAIN SURGERY","code_information":[{"code":"61720","type":"CPT"}],"standard_charges":[{"minimum":1339.99,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL/BRAIN SURGERY","code_information":[{"code":"61735","type":"CPT"}],"standard_charges":[{"minimum":1678.65,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1678.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1678.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1678.65,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL/BRAIN BIOPSY","code_information":[{"code":"61750","type":"CPT"}],"standard_charges":[{"minimum":1480.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.18,"methodology":"fee schedule"}]}]},{"description":"BRAIN BIOPSY W/CT/MR GUIDE","code_information":[{"code":"61751","type":"CPT"}],"standard_charges":[{"minimum":1463.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1463.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1463.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1463.01,"methodology":"fee schedule"}]}]},{"description":"IMPLANT BRAIN ELECTRODES","code_information":[{"code":"61760","type":"CPT"}],"standard_charges":[{"minimum":1657.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1657.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1657.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1657.2,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL FOR TREATMENT","code_information":[{"code":"61770","type":"CPT"}],"standard_charges":[{"minimum":1702.97,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1702.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"SCAN PROC CRANIAL INTRA","code_information":[{"code":"61781","type":"CPT"}],"standard_charges":[{"minimum":243.54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.54,"methodology":"fee schedule"}]}]},{"description":"SCAN PROC CRANIAL EXTRA","code_information":[{"code":"61782","type":"CPT"}],"standard_charges":[{"minimum":179.52,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"}]}]},{"description":"SCAN PROC SPINAL","code_information":[{"code":"61783","type":"CPT"}],"standard_charges":[{"minimum":239.25,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"}]}]},{"description":"TREAT TRIGEMINAL NERVE","code_information":[{"code":"61790","type":"CPT"}],"standard_charges":[{"minimum":931.95,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":931.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"TREAT TRIGEMINAL TRACT","code_information":[{"code":"61791","type":"CPT"}],"standard_charges":[{"minimum":1188.72,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"SRS CRANIAL LESION SIMPLE","code_information":[{"code":"61796","type":"CPT"}],"standard_charges":[{"minimum":1073.57,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.57,"methodology":"fee schedule"}]}]},{"description":"SRS CRAN LES SIMPLE ADDL","code_information":[{"code":"61797","type":"CPT"}],"standard_charges":[{"minimum":227.09,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"}]}]},{"description":"SRS CRANIAL LESION COMPLEX","code_information":[{"code":"61798","type":"CPT"}],"standard_charges":[{"minimum":1450.85,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1450.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1450.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1450.85,"methodology":"fee schedule"}]}]},{"description":"SRS CRAN LES COMPLEX ADDL","code_information":[{"code":"61799","type":"CPT"}],"standard_charges":[{"minimum":313.63,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.63,"methodology":"fee schedule"}]}]},{"description":"APPLY SRS HEADFRAME ADD-ON","code_information":[{"code":"61800","type":"CPT"}],"standard_charges":[{"minimum":156.28,"maximum":2198.42,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"61850","type":"CPT"}],"standard_charges":[{"minimum":1041.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1041.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1041.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1041.38,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"61860","type":"CPT"}],"standard_charges":[{"minimum":1642.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1642.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1642.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1642.18,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODE","code_information":[{"code":"61863","type":"CPT"}],"standard_charges":[{"minimum":1585.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1585.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1585.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1585.32,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRDE ADDL","code_information":[{"code":"61864","type":"CPT"}],"standard_charges":[{"minimum":292.17,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.17,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODE","code_information":[{"code":"61867","type":"CPT"}],"standard_charges":[{"minimum":2389.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2389.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2389.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2389.6,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRDE ADDL","code_information":[{"code":"61868","type":"CPT"}],"standard_charges":[{"minimum":515.68,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.68,"methodology":"fee schedule"}]}]},{"description":"REVISE/REMOVE NEUROELECTRODE","code_information":[{"code":"61880","type":"CPT"}],"standard_charges":[{"minimum":622.97,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3702.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3775.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3738.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3757.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"}]}]},{"description":"INSRT/REDO NEUROSTIM 1 ARRAY","code_information":[{"code":"61885","type":"CPT"}],"standard_charges":[{"minimum":560.03,"maximum":23541.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23084.42,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23541.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23312.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23427.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROSTIM ARRAYS","code_information":[{"code":"61886","type":"CPT"}],"standard_charges":[{"minimum":933.74,"maximum":33453.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6679,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6786,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32804.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33453.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33128.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33291.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"}]}]},{"description":"REVISE/REMOVE NEURORECEIVER","code_information":[{"code":"61888","type":"CPT"}],"standard_charges":[{"minimum":419.84,"maximum":13689.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13424.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13689.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13556.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13623.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"}]}]},{"description":"TREAT SKULL FRACTURE","code_information":[{"code":"62000","type":"CPT"}],"standard_charges":[{"minimum":1092.52,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"TREAT SKULL FRACTURE","code_information":[{"code":"62005","type":"CPT"}],"standard_charges":[{"minimum":1341.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.06,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF HEAD INJURY","code_information":[{"code":"62010","type":"CPT"}],"standard_charges":[{"minimum":1618.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.22,"methodology":"fee schedule"}]}]},{"description":"REPAIR BRAIN FLUID LEAKAGE","code_information":[{"code":"62100","type":"CPT"}],"standard_charges":[{"minimum":1653.62,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.62,"methodology":"fee schedule"}]}]},{"description":"REDUCTION OF SKULL DEFECT","code_information":[{"code":"62115","type":"CPT"}],"standard_charges":[{"minimum":1777.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1777.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1777.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1777.36,"methodology":"fee schedule"}]}]},{"description":"REDUCTION OF SKULL DEFECT","code_information":[{"code":"62117","type":"CPT"}],"standard_charges":[{"minimum":2059.87,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2059.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2059.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2059.87,"methodology":"fee schedule"}]}]},{"description":"REPAIR SKULL CAVITY LESION","code_information":[{"code":"62120","type":"CPT"}],"standard_charges":[{"minimum":2181.46,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2181.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2181.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2181.46,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL REPAIR","code_information":[{"code":"62121","type":"CPT"}],"standard_charges":[{"minimum":1637.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1637.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1637.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1637.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SKULL DEFECT","code_information":[{"code":"62140","type":"CPT"}],"standard_charges":[{"minimum":1077.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.14,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SKULL DEFECT","code_information":[{"code":"62141","type":"CPT"}],"standard_charges":[{"minimum":1204.45,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.45,"methodology":"fee schedule"}]}]},{"description":"REMOVE SKULL PLATE/FLAP","code_information":[{"code":"62142","type":"CPT"}],"standard_charges":[{"minimum":943.04,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.04,"methodology":"fee schedule"}]}]},{"description":"REPLACE SKULL PLATE/FLAP","code_information":[{"code":"62143","type":"CPT"}],"standard_charges":[{"minimum":1101.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.1,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SKULL  BRAIN","code_information":[{"code":"62145","type":"CPT"}],"standard_charges":[{"minimum":1494.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1494.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1494.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1494.12,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SKULL WITH GRAFT","code_information":[{"code":"62146","type":"CPT"}],"standard_charges":[{"minimum":1317.82,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.82,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SKULL WITH GRAFT","code_information":[{"code":"62147","type":"CPT"}],"standard_charges":[{"minimum":1489.47,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.47,"methodology":"fee schedule"}]}]},{"description":"RETR BONE FLAP TO FIX SKULL","code_information":[{"code":"62148","type":"CPT"}],"standard_charges":[{"minimum":130.17,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.17,"methodology":"fee schedule"}]}]},{"description":"NEUROENDOSCOPY ADD-ON","code_information":[{"code":"62160","type":"CPT"}],"standard_charges":[{"minimum":194.19,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.19,"methodology":"fee schedule"}]}]},{"description":"DISSECT BRAIN W/SCOPE","code_information":[{"code":"62161","type":"CPT"}],"standard_charges":[{"minimum":1605.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1605.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1605.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1605.34,"methodology":"fee schedule"}]}]},{"description":"REMOVE COLLOID CYST W/SCOPE","code_information":[{"code":"62162","type":"CPT"}],"standard_charges":[{"minimum":1984.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1984.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1984.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1984.77,"methodology":"fee schedule"}]}]},{"description":"REMOVE BRAIN TUMOR W/SCOPE","code_information":[{"code":"62164","type":"CPT"}],"standard_charges":[{"minimum":2200.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2200.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2200.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2200.78,"methodology":"fee schedule"}]}]},{"description":"REMOVE PITUIT TUMOR W/SCOPE","code_information":[{"code":"62165","type":"CPT"}],"standard_charges":[{"minimum":1593.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1593.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1593.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1593.54,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62180","type":"CPT"}],"standard_charges":[{"minimum":1682.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1682.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1682.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1682.23,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62190","type":"CPT"}],"standard_charges":[{"minimum":984.16,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.16,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62192","type":"CPT"}],"standard_charges":[{"minimum":1050.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.32,"methodology":"fee schedule"}]}]},{"description":"REPLACE/IRRIGATE CATHETER","code_information":[{"code":"62194","type":"CPT"}],"standard_charges":[{"minimum":525.34,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62200","type":"CPT"}],"standard_charges":[{"minimum":1448.71,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1448.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1448.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1448.71,"methodology":"fee schedule"}]}]},{"description":"BRAIN CAVITY SHUNT W/SCOPE","code_information":[{"code":"62201","type":"CPT"}],"standard_charges":[{"minimum":1282.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.77,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62220","type":"CPT"}],"standard_charges":[{"minimum":1026.72,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1026.72,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62223","type":"CPT"}],"standard_charges":[{"minimum":1090.37,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.37,"methodology":"fee schedule"}]}]},{"description":"REPLACE/IRRIGATE CATHETER","code_information":[{"code":"62225","type":"CPT"}],"standard_charges":[{"minimum":570.04,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPLACE/REVISE BRAIN SHUNT","code_information":[{"code":"62230","type":"CPT"}],"standard_charges":[{"minimum":887.61,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":887.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":887.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":887.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"CSF SHUNT REPROGRAM","code_information":[{"code":"62252","type":"CPT"}],"standard_charges":[{"minimum":89.76,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":322.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":329.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":326.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":327.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"}]}]},{"description":"REMOVE BRAIN CAVITY SHUNT","code_information":[{"code":"62256","type":"CPT"}],"standard_charges":[{"minimum":649.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.79,"methodology":"fee schedule"}]}]},{"description":"REPLACE BRAIN CAVITY SHUNT","code_information":[{"code":"62258","type":"CPT"}],"standard_charges":[{"minimum":1174.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.06,"methodology":"fee schedule"}]}]},{"description":"EPIDURAL LYSIS MULT SESSIONS","code_information":[{"code":"62263","type":"CPT"}],"standard_charges":[{"minimum":341.17,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"EPIDURAL LYSIS ON SINGLE DAY","code_information":[{"code":"62264","type":"CPT"}],"standard_charges":[{"minimum":256.41,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INTERDISCAL PERQ ASPIR DX","code_information":[{"code":"62267","type":"CPT"}],"standard_charges":[{"minimum":159.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"DRAIN SPINAL CORD CYST","code_information":[{"code":"62268","type":"CPT"}],"standard_charges":[{"minimum":342.95,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BIOPSY SPINAL CORD","code_information":[{"code":"62269","type":"CPT"}],"standard_charges":[{"minimum":269.29,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DX LMBR SPI PNXR","code_information":[{"code":"62270","type":"CPT"}],"standard_charges":[{"minimum":66.16,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"THER SPI PNXR DRG CSF","code_information":[{"code":"62272","type":"CPT"}],"standard_charges":[{"minimum":95.48,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"INJECT EPIDURAL PATCH","code_information":[{"code":"62273","type":"CPT"}],"standard_charges":[{"minimum":118.37,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"TREAT SPINAL CORD LESION","code_information":[{"code":"62280","type":"CPT"}],"standard_charges":[{"minimum":167.72,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"TREAT SPINAL CORD LESION","code_information":[{"code":"62281","type":"CPT"}],"standard_charges":[{"minimum":163.07,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"TREAT SPINAL CANAL LESION","code_information":[{"code":"62282","type":"CPT"}],"standard_charges":[{"minimum":149.13,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR MYELOGRAM","code_information":[{"code":"62284","type":"CPT"}],"standard_charges":[{"minimum":86.54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":249.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":249.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"}]}]},{"description":"PERCUTANEOUS DISKECTOMY","code_information":[{"code":"62287","type":"CPT"}],"standard_charges":[{"minimum":634.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"NJX PX DISCOGRAPHY LUMBAR","code_information":[{"code":"62290","type":"CPT"}],"standard_charges":[{"minimum":163.07,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.07,"methodology":"fee schedule"}]}]},{"description":"NJX PX DISCOGRAPHY CRV/THRC","code_information":[{"code":"62291","type":"CPT"}],"standard_charges":[{"minimum":148.77,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"}]}]},{"description":"NJX CHEMONUCLEOLYSIS LMBR","code_information":[{"code":"62292","type":"CPT"}],"standard_charges":[{"minimum":612.96,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INJECTION INTO SPINAL ARTERY","code_information":[{"code":"62294","type":"CPT"}],"standard_charges":[{"minimum":948.89,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"MYELOGRAPHY LUMBAR INJECTION","code_information":[{"code":"62302","type":"CPT"}],"standard_charges":[{"minimum":123.38,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"MYELOGRAPHY LUMBAR INJECTION","code_information":[{"code":"62303","type":"CPT"}],"standard_charges":[{"minimum":123.38,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"MYELOGRAPHY LUMBAR INJECTION","code_information":[{"code":"62304","type":"CPT"}],"standard_charges":[{"minimum":121.95,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"MYELOGRAPHY LUMBAR INJECTION","code_information":[{"code":"62305","type":"CPT"}],"standard_charges":[{"minimum":126.6,"maximum":3146,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"NJX INTERLAMINAR CRV/THRC","code_information":[{"code":"62320","type":"CPT"}],"standard_charges":[{"minimum":104.42,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":645.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":484.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":484.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX INTERLAMINAR CRV/THRC","code_information":[{"code":"62321","type":"CPT"}],"standard_charges":[{"minimum":112.65,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":811.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX INTERLAMINAR LMBR/SAC","code_information":[{"code":"62322","type":"CPT"}],"standard_charges":[{"minimum":82.97,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":632.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":474.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":474.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX INTERLAMINAR LMBR/SAC","code_information":[{"code":"62323","type":"CPT"}],"standard_charges":[{"minimum":104.07,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":798.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":599.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":599.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX INTERLAMINAR CRV/THRC","code_information":[{"code":"62324","type":"CPT"}],"standard_charges":[{"minimum":92.98,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":488.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":488.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX INTERLAMINAR CRV/THRC","code_information":[{"code":"62325","type":"CPT"}],"standard_charges":[{"minimum":115.51,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":817.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":613.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":613.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX INTERLAMINAR LMBR/SAC","code_information":[{"code":"62326","type":"CPT"}],"standard_charges":[{"minimum":89.05,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":677.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":508.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":508.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX INTERLAMINAR LMBR/SAC","code_information":[{"code":"62327","type":"CPT"}],"standard_charges":[{"minimum":112.29,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":843.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":633.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":633.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"DX LMBR SPI PNXR W/FLUOR/CT","code_information":[{"code":"62328","type":"CPT"}],"standard_charges":[{"minimum":88.69,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"THER SPI PNXR CSF FLUOR/CT","code_information":[{"code":"62329","type":"CPT"}],"standard_charges":[{"minimum":108.36,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"IMPLANT SPINAL CANAL CATH","code_information":[{"code":"62350","type":"CPT"}],"standard_charges":[{"minimum":419.84,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"IMPLANT SPINAL CANAL CATH","code_information":[{"code":"62351","type":"CPT"}],"standard_charges":[{"minimum":963.42,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINAL CANAL CATHETER","code_information":[{"code":"62355","type":"CPT"}],"standard_charges":[{"minimum":291.82,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INSERT SPINE INFUSION DEVICE","code_information":[{"code":"62360","type":"CPT"}],"standard_charges":[{"minimum":327.58,"maximum":19402.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19025.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19402.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19214.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19308.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"}]}]},{"description":"IMPLANT SPINE INFUSION PUMP","code_information":[{"code":"62361","type":"CPT"}],"standard_charges":[{"minimum":461.33,"maximum":19402.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19025.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19402.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19214.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19308.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"}]}]},{"description":"IMPLANT SPINE INFUSION PUMP","code_information":[{"code":"62362","type":"CPT"}],"standard_charges":[{"minimum":406.61,"maximum":19402.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19025.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19402.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19214.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19308.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.43,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE INFUSION DEVICE","code_information":[{"code":"62365","type":"CPT"}],"standard_charges":[{"minimum":315.06,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"ANALYZE SPINE INFUS PUMP","code_information":[{"code":"62367","type":"CPT"}],"standard_charges":[{"minimum":26.11,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":322.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":329.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":326.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":327.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"}]}]},{"description":"ANALYZE SP INF PUMP W/REPROG","code_information":[{"code":"62368","type":"CPT"}],"standard_charges":[{"minimum":35.76,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":322.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":329.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":326.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":327.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"}]}]},{"description":"ANAL SP INF PMP W/REPRGFILL","code_information":[{"code":"62369","type":"CPT"}],"standard_charges":[{"minimum":36.48,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":322.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":329.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":326.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":327.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"}]}]},{"description":"ANL SP INF PMP W/MDREPRGFIL","code_information":[{"code":"62370","type":"CPT"}],"standard_charges":[{"minimum":47.92,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":322.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":329.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":326.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":327.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":319.65,"methodology":"fee schedule"}]}]},{"description":"NDSC DCMPRN 1 NTRSPC LUMBAR","code_information":[{"code":"62380","type":"CPT"}],"standard_charges":[{"minimum":4345,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA 1/2 CRVL","code_information":[{"code":"63001","type":"CPT"}],"standard_charges":[{"minimum":1293.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA 1/2 THRC","code_information":[{"code":"63003","type":"CPT"}],"standard_charges":[{"minimum":1298.51,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1298.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1298.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1298.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA 1/2 LMBR","code_information":[{"code":"63005","type":"CPT"}],"standard_charges":[{"minimum":1264.53,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA 1/2 SCRL","code_information":[{"code":"63011","type":"CPT"}],"standard_charges":[{"minimum":1146.88,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE LAMINA/FACETS LUMBAR","code_information":[{"code":"63012","type":"CPT"}],"standard_charges":[{"minimum":1256.31,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1256.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1256.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1256.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA >2 CRVCL","code_information":[{"code":"63015","type":"CPT"}],"standard_charges":[{"minimum":1558.14,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1558.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1558.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1558.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA >2 THRC","code_information":[{"code":"63016","type":"CPT"}],"standard_charges":[{"minimum":1602.84,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1602.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1602.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1602.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA >2 LMBR","code_information":[{"code":"63017","type":"CPT"}],"standard_charges":[{"minimum":1332.48,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1332.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1332.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1332.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"NECK SPINE DISK SURGERY","code_information":[{"code":"63020","type":"CPT"}],"standard_charges":[{"minimum":1156.89,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1156.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1156.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1156.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"LOW BACK DISK SURGERY","code_information":[{"code":"63030","type":"CPT"}],"standard_charges":[{"minimum":964.85,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":964.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":964.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":964.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"SPINAL DISK SURGERY ADD-ON","code_information":[{"code":"63035","type":"CPT"}],"standard_charges":[{"minimum":241.75,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.75,"methodology":"fee schedule"}]}]},{"description":"LAMINOTOMY SINGLE CERVICAL","code_information":[{"code":"63040","type":"CPT"}],"standard_charges":[{"minimum":1446.92,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1446.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1446.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1446.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"LAMINOTOMY SINGLE LUMBAR","code_information":[{"code":"63042","type":"CPT"}],"standard_charges":[{"minimum":1362.52,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"LAMINOTOMY ADDL CERVICAL","code_information":[{"code":"63043","type":"CPT"}],"standard_charges":[{"minimum":196.4,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.4,"methodology":"fee schedule"}]}]},{"description":"LAMINOTOMY ADDL LUMBAR","code_information":[{"code":"63044","type":"CPT"}],"standard_charges":[{"minimum":182.38,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA 1 CRVL","code_information":[{"code":"63045","type":"CPT"}],"standard_charges":[{"minimum":1355.01,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1355.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1355.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1355.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA 1 THRC","code_information":[{"code":"63046","type":"CPT"}],"standard_charges":[{"minimum":1294.22,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE LAMINA 1 LMBR","code_information":[{"code":"63047","type":"CPT"}],"standard_charges":[{"minimum":1164.4,"maximum":9595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7146,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINAL LAMINA ADD-ON","code_information":[{"code":"63048","type":"CPT"}],"standard_charges":[{"minimum":217.79,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.79,"methodology":"fee schedule"}]}]},{"description":"CERVICAL LAMINOPLSTY 2/> SEG","code_information":[{"code":"63050","type":"CPT"}],"standard_charges":[{"minimum":1539.9,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1539.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1539.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1539.9,"methodology":"fee schedule"}]}]},{"description":"C-LAMINOPLASTY W/GRAFT/PLATE","code_information":[{"code":"63051","type":"CPT"}],"standard_charges":[{"minimum":1773.78,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1773.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1773.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1773.78,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS SPINAL CORD THRC","code_information":[{"code":"63055","type":"CPT"}],"standard_charges":[{"minimum":1705.12,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1705.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1705.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1705.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS SPINAL CORD LMBR","code_information":[{"code":"63056","type":"CPT"}],"standard_charges":[{"minimum":1563.5,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1563.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1563.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1563.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS SPINE CORD ADD-ON","code_information":[{"code":"63057","type":"CPT"}],"standard_charges":[{"minimum":332.23,"maximum":3048.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.23,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS SPINAL CORD THRC","code_information":[{"code":"63064","type":"CPT"}],"standard_charges":[{"minimum":1862.47,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1862.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1862.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1862.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS SPINE CORD ADD-ON","code_information":[{"code":"63066","type":"CPT"}],"standard_charges":[{"minimum":212.07,"maximum":3048.53,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.07,"methodology":"fee schedule"}]}]},{"description":"NECK SPINE DISK SURGERY","code_information":[{"code":"63075","type":"CPT"}],"standard_charges":[{"minimum":1421.17,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"NECK SPINE DISK SURGERY","code_information":[{"code":"63076","type":"CPT"}],"standard_charges":[{"minimum":250.33,"maximum":4104.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.33,"methodology":"fee schedule"}]}]},{"description":"SPINE DISK SURGERY THORAX","code_information":[{"code":"63077","type":"CPT"}],"standard_charges":[{"minimum":1530.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1530.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1530.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1530.96,"methodology":"fee schedule"}]}]},{"description":"SPINE DISK SURGERY THORAX","code_information":[{"code":"63078","type":"CPT"}],"standard_charges":[{"minimum":213.5,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.5,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT BODY DCMPRN CRVL","code_information":[{"code":"63081","type":"CPT"}],"standard_charges":[{"minimum":1847.81,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1847.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1847.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1847.81,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63082","type":"CPT"}],"standard_charges":[{"minimum":275.37,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.37,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT BODY DCMPRN THRC","code_information":[{"code":"63085","type":"CPT"}],"standard_charges":[{"minimum":2033.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.77,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63086","type":"CPT"}],"standard_charges":[{"minimum":198.12,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.12,"methodology":"fee schedule"}]}]},{"description":"REMOV VERTBR DCMPRN THRCLMBR","code_information":[{"code":"63087","type":"CPT"}],"standard_charges":[{"minimum":2530.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2530.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2530.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2530.14,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63088","type":"CPT"}],"standard_charges":[{"minimum":267.86,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT BODY DCMPRN LMBR","code_information":[{"code":"63090","type":"CPT"}],"standard_charges":[{"minimum":2036.63,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2036.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2036.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2036.63,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63091","type":"CPT"}],"standard_charges":[{"minimum":181.67,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT BODY DCMPRN THRC","code_information":[{"code":"63101","type":"CPT"}],"standard_charges":[{"minimum":2436.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2436.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2436.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2436.09,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT BODY DCMPRN LMBR","code_information":[{"code":"63102","type":"CPT"}],"standard_charges":[{"minimum":2393.89,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2393.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2393.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2393.89,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63103","type":"CPT"}],"standard_charges":[{"minimum":303.62,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"}]}]},{"description":"INCISE SPINAL CORD TRACT(S)","code_information":[{"code":"63170","type":"CPT"}],"standard_charges":[{"minimum":1677.94,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1677.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1677.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1677.94,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SPINAL CYST","code_information":[{"code":"63172","type":"CPT"}],"standard_charges":[{"minimum":1487.69,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1487.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1487.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1487.69,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF SPINAL CYST","code_information":[{"code":"63173","type":"CPT"}],"standard_charges":[{"minimum":1815.62,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1815.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1815.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1815.62,"methodology":"fee schedule"}]}]},{"description":"INCISE SPINE NRV HALF SEGMNT","code_information":[{"code":"63185","type":"CPT"}],"standard_charges":[{"minimum":1297.79,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.79,"methodology":"fee schedule"}]}]},{"description":"INCISE SPINE NRV >2 SEGMNTS","code_information":[{"code":"63190","type":"CPT"}],"standard_charges":[{"minimum":1302.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.8,"methodology":"fee schedule"}]}]},{"description":"INCISE SPINE ACCESSORY NERVE","code_information":[{"code":"63191","type":"CPT"}],"standard_charges":[{"minimum":1456.57,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.57,"methodology":"fee schedule"}]}]},{"description":"INCISE SPINECORD 2 TRX THRC","code_information":[{"code":"63197","type":"CPT"}],"standard_charges":[{"minimum":1800.24,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1800.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1800.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1800.24,"methodology":"fee schedule"}]}]},{"description":"RELEASE SPINAL CORD LUMBAR","code_information":[{"code":"63200","type":"CPT"}],"standard_charges":[{"minimum":1612.85,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1612.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1612.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1612.85,"methodology":"fee schedule"}]}]},{"description":"REVISE SPINAL CORD VSLS CRVL","code_information":[{"code":"63250","type":"CPT"}],"standard_charges":[{"minimum":3096.96,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3096.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3096.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3096.96,"methodology":"fee schedule"}]}]},{"description":"REVISE SPINAL CORD VSLS THRC","code_information":[{"code":"63251","type":"CPT"}],"standard_charges":[{"minimum":3166.7,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3166.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3166.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3166.7,"methodology":"fee schedule"}]}]},{"description":"REVISE SPINE CORD VSL THRLMB","code_information":[{"code":"63252","type":"CPT"}],"standard_charges":[{"minimum":3166.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3166.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3166.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3166.34,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTRASPINL LESION CRV","code_information":[{"code":"63265","type":"CPT"}],"standard_charges":[{"minimum":1755.18,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1755.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1755.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1755.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTRSPINL LESION THRC","code_information":[{"code":"63266","type":"CPT"}],"standard_charges":[{"minimum":1802.03,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1802.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1802.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1802.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTRSPINL LESION LMBR","code_information":[{"code":"63267","type":"CPT"}],"standard_charges":[{"minimum":1443.34,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTRSPINL LESION SCRL","code_information":[{"code":"63268","type":"CPT"}],"standard_charges":[{"minimum":1541.69,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1541.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1541.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1541.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTRSPINL LESION CRVL","code_information":[{"code":"63270","type":"CPT"}],"standard_charges":[{"minimum":2180.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2180.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2180.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2180.03,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTRSPINL LESION THRC","code_information":[{"code":"63271","type":"CPT"}],"standard_charges":[{"minimum":2174.31,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2174.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2174.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2174.31,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTRSPINL LESION LMBR","code_information":[{"code":"63272","type":"CPT"}],"standard_charges":[{"minimum":1966.18,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1966.18,"methodology":"fee schedule"}]}]},{"description":"EXCISE INTRSPINL LESION SCRL","code_information":[{"code":"63273","type":"CPT"}],"standard_charges":[{"minimum":1963.32,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1963.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1963.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1963.32,"methodology":"fee schedule"}]}]},{"description":"BX/EXC XDRL SPINE LESN CRVL","code_information":[{"code":"63275","type":"CPT"}],"standard_charges":[{"minimum":1890.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1890.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1890.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1890.01,"methodology":"fee schedule"}]}]},{"description":"BX/EXC XDRL SPINE LESN THRC","code_information":[{"code":"63276","type":"CPT"}],"standard_charges":[{"minimum":1878.2,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1878.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1878.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1878.2,"methodology":"fee schedule"}]}]},{"description":"BX/EXC XDRL SPINE LESN LMBR","code_information":[{"code":"63277","type":"CPT"}],"standard_charges":[{"minimum":1640.75,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.75,"methodology":"fee schedule"}]}]},{"description":"BX/EXC XDRL SPINE LESN SCRL","code_information":[{"code":"63278","type":"CPT"}],"standard_charges":[{"minimum":1679.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.01,"methodology":"fee schedule"}]}]},{"description":"BX/EXC IDRL SPINE LESN CRVL","code_information":[{"code":"63280","type":"CPT"}],"standard_charges":[{"minimum":2224.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2224.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2224.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2224.38,"methodology":"fee schedule"}]}]},{"description":"BX/EXC IDRL SPINE LESN THRC","code_information":[{"code":"63281","type":"CPT"}],"standard_charges":[{"minimum":2206.14,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2206.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2206.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2206.14,"methodology":"fee schedule"}]}]},{"description":"BX/EXC IDRL SPINE LESN LMBR","code_information":[{"code":"63282","type":"CPT"}],"standard_charges":[{"minimum":2080.26,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2080.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2080.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2080.26,"methodology":"fee schedule"}]}]},{"description":"BX/EXC IDRL SPINE LESN SCRL","code_information":[{"code":"63283","type":"CPT"}],"standard_charges":[{"minimum":2001.58,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2001.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2001.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2001.58,"methodology":"fee schedule"}]}]},{"description":"BX/EXC IDRL IMED LESN CERVL","code_information":[{"code":"63285","type":"CPT"}],"standard_charges":[{"minimum":2737.92,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2737.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2737.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2737.92,"methodology":"fee schedule"}]}]},{"description":"BX/EXC IDRL IMED LESN THRC","code_information":[{"code":"63286","type":"CPT"}],"standard_charges":[{"minimum":2694.29,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2694.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2694.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2694.29,"methodology":"fee schedule"}]}]},{"description":"BX/EXC IDRL IMED LESN THRLMB","code_information":[{"code":"63287","type":"CPT"}],"standard_charges":[{"minimum":2869.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2869.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2869.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2869.88,"methodology":"fee schedule"}]}]},{"description":"BX/EXC XDRL/IDRL LSN ANY LVL","code_information":[{"code":"63290","type":"CPT"}],"standard_charges":[{"minimum":2917.8,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2917.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2917.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2917.8,"methodology":"fee schedule"}]}]},{"description":"REPAIR LAMINECTOMY DEFECT","code_information":[{"code":"63295","type":"CPT"}],"standard_charges":[{"minimum":340.09,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT XDRL BODY CRVCL","code_information":[{"code":"63300","type":"CPT"}],"standard_charges":[{"minimum":1900.38,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1900.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1900.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1900.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT XDRL BODY THRC","code_information":[{"code":"63301","type":"CPT"}],"standard_charges":[{"minimum":2315.21,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2315.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2315.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2315.21,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT XDRL BODY THRLMB","code_information":[{"code":"63302","type":"CPT"}],"standard_charges":[{"minimum":2287.68,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2287.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2287.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2287.68,"methodology":"fee schedule"}]}]},{"description":"REMOV VERT XDRL BDY LMBR/SAC","code_information":[{"code":"63303","type":"CPT"}],"standard_charges":[{"minimum":2425,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2425,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2425,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2425,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT IDRL BODY CRVCL","code_information":[{"code":"63304","type":"CPT"}],"standard_charges":[{"minimum":2462.91,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2462.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2462.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2462.91,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERT IDRL BODY THRC","code_information":[{"code":"63305","type":"CPT"}],"standard_charges":[{"minimum":2619.54,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2619.54,"methodology":"fee schedule"}]}]},{"description":"REMOV VERT IDRL BDY THRCLMBR","code_information":[{"code":"63306","type":"CPT"}],"standard_charges":[{"minimum":2574.13,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2574.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2574.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2574.13,"methodology":"fee schedule"}]}]},{"description":"REMOV VERT IDRL BDY LMBR/SAC","code_information":[{"code":"63307","type":"CPT"}],"standard_charges":[{"minimum":2519.77,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2519.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2519.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2519.77,"methodology":"fee schedule"}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63308","type":"CPT"}],"standard_charges":[{"minimum":331.87,"maximum":4110,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4104.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3078.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.87,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINAL CORD LESION","code_information":[{"code":"63600","type":"CPT"}],"standard_charges":[{"minimum":1153.31,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1153.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1153.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1153.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"STIMULATION OF SPINAL CORD","code_information":[{"code":"63610","type":"CPT"}],"standard_charges":[{"minimum":602.94,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"SRS SPINAL LESION","code_information":[{"code":"63620","type":"CPT"}],"standard_charges":[{"minimum":1185.86,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.86,"methodology":"fee schedule"}]}]},{"description":"SRS SPINAL LESION ADDL","code_information":[{"code":"63621","type":"CPT"}],"standard_charges":[{"minimum":260.7,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2198.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1649.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.7,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"63650","type":"CPT"}],"standard_charges":[{"minimum":435.94,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7064.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7204.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7169.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"63655","type":"CPT"}],"standard_charges":[{"minimum":885.82,"maximum":23541.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15197.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11400.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11400.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23084.42,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23541.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23312.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23427.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE ELTRD PERQ ARAY","code_information":[{"code":"63661","type":"CPT"}],"standard_charges":[{"minimum":346.89,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE SPINE ELTRD PLATE","code_information":[{"code":"63662","type":"CPT"}],"standard_charges":[{"minimum":899.05,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":899.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":899.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":899.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3702.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3775.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3738.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3757.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"}]}]},{"description":"REVISE SPINE ELTRD PERQ ARAY","code_information":[{"code":"63663","type":"CPT"}],"standard_charges":[{"minimum":474.92,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7064.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7204.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7169.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"}]}]},{"description":"REVISE SPINE ELTRD PLATE","code_information":[{"code":"63664","type":"CPT"}],"standard_charges":[{"minimum":935.53,"maximum":13689.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13424.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13689.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13556.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13623.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"}]}]},{"description":"INSRT/REDO SPINE N GENERATOR","code_information":[{"code":"63685","type":"CPT"}],"standard_charges":[{"minimum":358.33,"maximum":33453.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32804.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33453.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33128.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33291.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"}]}]},{"description":"REVISE/REMOVE NEURORECEIVER","code_information":[{"code":"63688","type":"CPT"}],"standard_charges":[{"minimum":316.49,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3702.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3775.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3738.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3757.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SPINAL HERNIATION","code_information":[{"code":"63700","type":"CPT"}],"standard_charges":[{"minimum":1386.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1386.12,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SPINAL HERNIATION","code_information":[{"code":"63702","type":"CPT"}],"standard_charges":[{"minimum":1512.36,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512.36,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SPINAL HERNIATION","code_information":[{"code":"63704","type":"CPT"}],"standard_charges":[{"minimum":1759.12,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1759.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1759.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1759.12,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF SPINAL HERNIATION","code_information":[{"code":"63706","type":"CPT"}],"standard_charges":[{"minimum":1950.09,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1950.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1950.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1950.09,"methodology":"fee schedule"}]}]},{"description":"REPAIR SPINAL FLUID LEAKAGE","code_information":[{"code":"63707","type":"CPT"}],"standard_charges":[{"minimum":989.53,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":989.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":989.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":989.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR SPINAL FLUID LEAKAGE","code_information":[{"code":"63709","type":"CPT"}],"standard_charges":[{"minimum":1174.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.06,"methodology":"fee schedule"}]}]},{"description":"GRAFT REPAIR OF SPINE DEFECT","code_information":[{"code":"63710","type":"CPT"}],"standard_charges":[{"minimum":1141.51,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1141.51,"methodology":"fee schedule"}]}]},{"description":"INSTALL SPINAL SHUNT","code_information":[{"code":"63740","type":"CPT"}],"standard_charges":[{"minimum":1043.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1043.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1043.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1043.88,"methodology":"fee schedule"}]}]},{"description":"INSTALL SPINAL SHUNT","code_information":[{"code":"63741","type":"CPT"}],"standard_charges":[{"minimum":722.03,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REVISION OF SPINAL SHUNT","code_information":[{"code":"63744","type":"CPT"}],"standard_charges":[{"minimum":724.17,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SPINAL SHUNT","code_information":[{"code":"63746","type":"CPT"}],"standard_charges":[{"minimum":649.43,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD TRIGEMINAL NRV","code_information":[{"code":"64400","type":"CPT"}],"standard_charges":[{"minimum":53.64,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD GR OCPL NRV","code_information":[{"code":"64405","type":"CPT"}],"standard_charges":[{"minimum":55.07,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD VAGUS NRV","code_information":[{"code":"64408","type":"CPT"}],"standard_charges":[{"minimum":46.85,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD BRACH PLEXUS","code_information":[{"code":"64415","type":"CPT"}],"standard_charges":[{"minimum":72.6,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD BRACH PLEX NFS","code_information":[{"code":"64416","type":"CPT"}],"standard_charges":[{"minimum":80.46,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD AXILLARY NRV","code_information":[{"code":"64417","type":"CPT"}],"standard_charges":[{"minimum":66.87,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD SPRSCAP NRV","code_information":[{"code":"64418","type":"CPT"}],"standard_charges":[{"minimum":57.93,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD NTRCOST NRV 1","code_information":[{"code":"64420","type":"CPT"}],"standard_charges":[{"minimum":60.79,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD NTRCOST NRV EA","code_information":[{"code":"64421","type":"CPT"}],"standard_charges":[{"minimum":26.11,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD II IH NERVES","code_information":[{"code":"64425","type":"CPT"}],"standard_charges":[{"minimum":56.86,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD PUDENDAL NERVE","code_information":[{"code":"64430","type":"CPT"}],"standard_charges":[{"minimum":57.22,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD PARACRV NRV","code_information":[{"code":"64435","type":"CPT"}],"standard_charges":[{"minimum":45.77,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD SCIATIC NERVE","code_information":[{"code":"64445","type":"CPT"}],"standard_charges":[{"minimum":75.1,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD SCIATIC NRV NFS","code_information":[{"code":"64446","type":"CPT"}],"standard_charges":[{"minimum":78.68,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD FEMORAL NERVE","code_information":[{"code":"64447","type":"CPT"}],"standard_charges":[{"minimum":65.8,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD FEM NERVE NFS","code_information":[{"code":"64448","type":"CPT"}],"standard_charges":[{"minimum":75.1,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD LMBR PLEX NFS","code_information":[{"code":"64449","type":"CPT"}],"standard_charges":[{"minimum":66.52,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD OTHER PN/BRANCH","code_information":[{"code":"64450","type":"CPT"}],"standard_charges":[{"minimum":43.99,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD NRV NRVTG SI JT","code_information":[{"code":"64451","type":"CPT"}],"standard_charges":[{"minimum":85.47,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"NJX AA/STRD GNCLR NRV BRNCH","code_information":[{"code":"64454","type":"CPT"}],"standard_charges":[{"minimum":86.19,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"N BLOCK INJ PLANTAR DIGIT","code_information":[{"code":"64455","type":"CPT"}],"standard_charges":[{"minimum":35.05,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"PVB THORACIC SINGLE INJ SITE","code_information":[{"code":"64461","type":"CPT"}],"standard_charges":[{"minimum":81.54,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":500.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":375.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":375.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"PVB THORACIC 2ND+ INJ SITE","code_information":[{"code":"64462","type":"CPT"}],"standard_charges":[{"minimum":50.42,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":314.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":235.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":235.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"}]}]},{"description":"PVB THORACIC CONT INFUSION","code_information":[{"code":"64463","type":"CPT"}],"standard_charges":[{"minimum":85.11,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":368.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":368.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"INJ FORAMEN EPIDURAL C/T","code_information":[{"code":"64479","type":"CPT"}],"standard_charges":[{"minimum":136.61,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1194.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1194.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INJ FORAMEN EPIDURAL ADD-ON","code_information":[{"code":"64480","type":"CPT"}],"standard_charges":[{"minimum":63.66,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":607.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":607.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.66,"methodology":"fee schedule"}]}]},{"description":"INJ FORAMEN EPIDURAL L/S","code_information":[{"code":"64483","type":"CPT"}],"standard_charges":[{"minimum":116.58,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1194.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1194.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INJ FORAMEN EPIDURAL ADD-ON","code_information":[{"code":"64484","type":"CPT"}],"standard_charges":[{"minimum":53.64,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":796.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":597.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":597.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"}]}]},{"description":"TAP BLOCK UNIL BY INJECTION","code_information":[{"code":"64486","type":"CPT"}],"standard_charges":[{"minimum":57.58,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.58,"methodology":"fee schedule"}]}]},{"description":"TAP BLOCK UNI BY INFUSION","code_information":[{"code":"64487","type":"CPT"}],"standard_charges":[{"minimum":66.16,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"}]}]},{"description":"TAP BLOCK BI INJECTION","code_information":[{"code":"64488","type":"CPT"}],"standard_charges":[{"minimum":71.52,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"}]}]},{"description":"TAP BLOCK BI BY INFUSION","code_information":[{"code":"64489","type":"CPT"}],"standard_charges":[{"minimum":80.46,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"}]}]},{"description":"INJ PARAVERT F JNT C/T 1 LEV","code_information":[{"code":"64490","type":"CPT"}],"standard_charges":[{"minimum":110.5,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1194.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1194.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INJ PARAVERT F JNT C/T 2 LEV","code_information":[{"code":"64491","type":"CPT"}],"standard_charges":[{"minimum":61.87,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":552.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"}]}]},{"description":"INJ PARAVERT F JNT C/T 3 LEV","code_information":[{"code":"64492","type":"CPT"}],"standard_charges":[{"minimum":62.94,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":552.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.94,"methodology":"fee schedule"}]}]},{"description":"INJ PARAVERT F JNT L/S 1 LEV","code_information":[{"code":"64493","type":"CPT"}],"standard_charges":[{"minimum":94.77,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1194.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1194.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INJ PARAVERT F JNT L/S 2 LEV","code_information":[{"code":"64494","type":"CPT"}],"standard_charges":[{"minimum":53.28,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":552.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"}]}]},{"description":"INJ PARAVERT F JNT L/S 3 LEV","code_information":[{"code":"64495","type":"CPT"}],"standard_charges":[{"minimum":54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":552.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"}]}]},{"description":"N BLOCK SPENOPALATINE GANGL","code_information":[{"code":"64505","type":"CPT"}],"standard_charges":[{"minimum":110.15,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"N BLOCK STELLATE GANGLION","code_information":[{"code":"64510","type":"CPT"}],"standard_charges":[{"minimum":80.82,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"N BLOCK INJ HYPOGAS PLXS","code_information":[{"code":"64517","type":"CPT"}],"standard_charges":[{"minimum":132.32,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"N BLOCK LUMBAR/THORACIC","code_information":[{"code":"64520","type":"CPT"}],"standard_charges":[{"minimum":89.05,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"N BLOCK INJ CELIAC PELUS","code_information":[{"code":"64530","type":"CPT"}],"standard_charges":[{"minimum":99.06,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64553","type":"CPT"}],"standard_charges":[{"minimum":473.48,"maximum":13689.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13424.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13689.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13556.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13623.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64555","type":"CPT"}],"standard_charges":[{"minimum":340.09,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7064.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7204.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7169.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64561","type":"CPT"}],"standard_charges":[{"minimum":317.56,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7064.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7204.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7169.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"}]}]},{"description":"NEUROELTRD STIM POST TIBIAL","code_information":[{"code":"64566","type":"CPT"}],"standard_charges":[{"minimum":31.47,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"INC FOR VAGUS N ELECT IMPL","code_information":[{"code":"64568","type":"CPT"}],"standard_charges":[{"minimum":635.49,"maximum":33453.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6679,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6786,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32804.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33453.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33128.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33291.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32479.36,"methodology":"fee schedule"}]}]},{"description":"REVISE/REPL VAGUS N ELTRD","code_information":[{"code":"64569","type":"CPT"}],"standard_charges":[{"minimum":812.15,"maximum":13689.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13424.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13689.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13556.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13623.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"}]}]},{"description":"REMOVE VAGUS N ELTRD","code_information":[{"code":"64570","type":"CPT"}],"standard_charges":[{"minimum":779.96,"maximum":9912,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64575","type":"CPT"}],"standard_charges":[{"minimum":331.15,"maximum":13689.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13424.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13689.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13556.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13623.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13291.11,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64580","type":"CPT"}],"standard_charges":[{"minimum":331.51,"maximum":23541.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23084.42,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23541.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23312.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23427.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64581","type":"CPT"}],"standard_charges":[{"minimum":687.7,"maximum":7204.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7064.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7204.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7169.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.87,"methodology":"fee schedule"}]}]},{"description":"REVISE/REMOVE NEUROELECTRODE","code_information":[{"code":"64585","type":"CPT"}],"standard_charges":[{"minimum":151.63,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3702.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3775.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3738.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3757.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"}]}]},{"description":"INSRT/REDO PN/GASTR STIMUL","code_information":[{"code":"64590","type":"CPT"}],"standard_charges":[{"minimum":309.34,"maximum":23541.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23084.42,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23541.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23312.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23427.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22855.86,"methodology":"fee schedule"}]}]},{"description":"REVISE/RMV PN/GASTR STIMUL","code_information":[{"code":"64595","type":"CPT"}],"standard_charges":[{"minimum":241.03,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3702.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3775.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3738.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3757.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3665.37,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64600","type":"CPT"}],"standard_charges":[{"minimum":248.9,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64605","type":"CPT"}],"standard_charges":[{"minimum":445.59,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64610","type":"CPT"}],"standard_charges":[{"minimum":502.81,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV SALIV GLANDS","code_information":[{"code":"64611","type":"CPT"}],"standard_charges":[{"minimum":118.73,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"DESTROY NERVE FACE MUSCLE","code_information":[{"code":"64612","type":"CPT"}],"standard_charges":[{"minimum":125.52,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV MUSC MIGRAINE","code_information":[{"code":"64615","type":"CPT"}],"standard_charges":[{"minimum":128.03,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":190.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":190.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV MUSC NECK DYSTON","code_information":[{"code":"64616","type":"CPT"}],"standard_charges":[{"minimum":114.44,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"CHEMODENER MUSCLE LARYNX EMG","code_information":[{"code":"64617","type":"CPT"}],"standard_charges":[{"minimum":113.36,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64620","type":"CPT"}],"standard_charges":[{"minimum":186.68,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"DSTRJ NULYT AGT GNCLR NRV","code_information":[{"code":"64624","type":"CPT"}],"standard_charges":[{"minimum":153.42,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"RF ABLTJ NRV NRVTG SI JT","code_information":[{"code":"64625","type":"CPT"}],"standard_charges":[{"minimum":205.27,"maximum":5286,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":721.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64630","type":"CPT"}],"standard_charges":[{"minimum":200.62,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"N BLOCK INJ COMMON DIGIT","code_information":[{"code":"64632","type":"CPT"}],"standard_charges":[{"minimum":70.81,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"DESTROY CERV/THOR FACET JNT","code_information":[{"code":"64633","type":"CPT"}],"standard_charges":[{"minimum":201.7,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1734.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1300.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1300.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"DESTROY C/TH FACET JNT ADDL","code_information":[{"code":"64634","type":"CPT"}],"standard_charges":[{"minimum":70.09,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":552.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":414.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.09,"methodology":"fee schedule"}]}]},{"description":"DESTROY LUMB/SAC FACET JNT","code_information":[{"code":"64635","type":"CPT"}],"standard_charges":[{"minimum":202.05,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1734.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1300.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1300.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"DESTROY L/S FACET JNT ADDL","code_information":[{"code":"64636","type":"CPT"}],"standard_charges":[{"minimum":61.15,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":867.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":650.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":650.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.15,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64640","type":"CPT"}],"standard_charges":[{"minimum":125.17,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1873.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1405.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV 1 EXTREMITY 1-4","code_information":[{"code":"64642","type":"CPT"}],"standard_charges":[{"minimum":111.93,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV 1 EXTREM 1-4 EA","code_information":[{"code":"64643","type":"CPT"}],"standard_charges":[{"minimum":72.95,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":357.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":357.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.95,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV 1 EXTREM 5/> MUS","code_information":[{"code":"64644","type":"CPT"}],"standard_charges":[{"minimum":121.23,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1430.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1072.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1072.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV 1 EXTREM 5/> EA","code_information":[{"code":"64645","type":"CPT"}],"standard_charges":[{"minimum":84.4,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":715,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":536.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":536.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.4,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV TRUNK MUSC 1-5","code_information":[{"code":"64646","type":"CPT"}],"standard_charges":[{"minimum":121.23,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":953.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":715.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV TRUNK MUSC 6/>","code_information":[{"code":"64647","type":"CPT"}],"standard_charges":[{"minimum":139.47,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1430.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1072.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1072.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":745.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":760.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":752.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":756.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":738.1,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV ECCRINE GLANDS","code_information":[{"code":"64650","type":"CPT"}],"standard_charges":[{"minimum":42.56,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"CHEMODENERV ECCRINE GLANDS","code_information":[{"code":"64653","type":"CPT"}],"standard_charges":[{"minimum":54,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64680","type":"CPT"}],"standard_charges":[{"minimum":168.44,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64681","type":"CPT"}],"standard_charges":[{"minimum":229.23,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":958.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":977.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":967.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":972.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":948.89,"methodology":"fee schedule"}]}]},{"description":"REVISE FINGER/TOE NERVE","code_information":[{"code":"64702","type":"CPT"}],"standard_charges":[{"minimum":547.15,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REVISE HAND/FOOT NERVE","code_information":[{"code":"64704","type":"CPT"}],"standard_charges":[{"minimum":344.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REVISE ARM/LEG NERVE","code_information":[{"code":"64708","type":"CPT"}],"standard_charges":[{"minimum":540.72,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":540.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":540.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":540.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REVISION OF SCIATIC NERVE","code_information":[{"code":"64712","type":"CPT"}],"standard_charges":[{"minimum":629.41,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REVISION OF ARM NERVE(S)","code_information":[{"code":"64713","type":"CPT"}],"standard_charges":[{"minimum":845.41,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REVISE LOW BACK NERVE(S)","code_information":[{"code":"64714","type":"CPT"}],"standard_charges":[{"minimum":808.21,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":808.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":808.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":808.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CRANIAL NERVE","code_information":[{"code":"64716","type":"CPT"}],"standard_charges":[{"minimum":541.07,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REVISE ULNAR NERVE AT ELBOW","code_information":[{"code":"64718","type":"CPT"}],"standard_charges":[{"minimum":641.92,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REVISE ULNAR NERVE AT WRIST","code_information":[{"code":"64719","type":"CPT"}],"standard_charges":[{"minimum":434.86,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"CARPAL TUNNEL SURGERY","code_information":[{"code":"64721","type":"CPT"}],"standard_charges":[{"minimum":466.33,"maximum":9595,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"RELIEVE PRESSURE ON NERVE(S)","code_information":[{"code":"64722","type":"CPT"}],"standard_charges":[{"minimum":393.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"RELEASE FOOT/TOE NERVE","code_information":[{"code":"64726","type":"CPT"}],"standard_charges":[{"minimum":285.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INTERNAL NERVE REVISION","code_information":[{"code":"64727","type":"CPT"}],"standard_charges":[{"minimum":186.68,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"}]}]},{"description":"INCISION OF BROW NERVE","code_information":[{"code":"64732","type":"CPT"}],"standard_charges":[{"minimum":483.86,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISION OF CHEEK NERVE","code_information":[{"code":"64734","type":"CPT"}],"standard_charges":[{"minimum":546.08,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISION OF CHIN NERVE","code_information":[{"code":"64736","type":"CPT"}],"standard_charges":[{"minimum":350.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":350.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISION OF JAW NERVE","code_information":[{"code":"64738","type":"CPT"}],"standard_charges":[{"minimum":473.48,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISION OF TONGUE NERVE","code_information":[{"code":"64740","type":"CPT"}],"standard_charges":[{"minimum":483.14,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISION OF FACIAL NERVE","code_information":[{"code":"64742","type":"CPT"}],"standard_charges":[{"minimum":521.05,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISE NERVE BACK OF HEAD","code_information":[{"code":"64744","type":"CPT"}],"standard_charges":[{"minimum":537.86,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISE DIAPHRAGM NERVE","code_information":[{"code":"64746","type":"CPT"}],"standard_charges":[{"minimum":451.31,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISION OF STOMACH NERVES","code_information":[{"code":"64755","type":"CPT"}],"standard_charges":[{"minimum":963.06,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.06,"methodology":"fee schedule"}]}]},{"description":"INCISION OF VAGUS NERVE","code_information":[{"code":"64760","type":"CPT"}],"standard_charges":[{"minimum":548.23,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.23,"methodology":"fee schedule"}]}]},{"description":"INCISE HIP/THIGH NERVE","code_information":[{"code":"64763","type":"CPT"}],"standard_charges":[{"minimum":542.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISE HIP/THIGH NERVE","code_information":[{"code":"64766","type":"CPT"}],"standard_charges":[{"minimum":668.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"SEVER CRANIAL NERVE","code_information":[{"code":"64771","type":"CPT"}],"standard_charges":[{"minimum":611.17,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"INCISION OF SPINAL NERVE","code_information":[{"code":"64772","type":"CPT"}],"standard_charges":[{"minimum":590.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":590.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":590.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":590.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE SKIN NERVE LESION","code_information":[{"code":"64774","type":"CPT"}],"standard_charges":[{"minimum":453.82,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE DIGIT NERVE LESION","code_information":[{"code":"64776","type":"CPT"}],"standard_charges":[{"minimum":430.21,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"DIGIT NERVE SURGERY ADD-ON","code_information":[{"code":"64778","type":"CPT"}],"standard_charges":[{"minimum":186.68,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.68,"methodology":"fee schedule"}]}]},{"description":"REMOVE LIMB NERVE LESION","code_information":[{"code":"64782","type":"CPT"}],"standard_charges":[{"minimum":482.78,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"LIMB NERVE SURGERY ADD-ON","code_information":[{"code":"64783","type":"CPT"}],"standard_charges":[{"minimum":222.44,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1174.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.44,"methodology":"fee schedule"}]}]},{"description":"REMOVE NERVE LESION","code_information":[{"code":"64784","type":"CPT"}],"standard_charges":[{"minimum":763.87,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE SCIATIC NERVE LESION","code_information":[{"code":"64786","type":"CPT"}],"standard_charges":[{"minimum":1051.04,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"IMPLANT NERVE END","code_information":[{"code":"64787","type":"CPT"}],"standard_charges":[{"minimum":242.46,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.46,"methodology":"fee schedule"}]}]},{"description":"REMOVE SKIN NERVE LESION","code_information":[{"code":"64788","type":"CPT"}],"standard_charges":[{"minimum":433.79,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NERVE LESION","code_information":[{"code":"64790","type":"CPT"}],"standard_charges":[{"minimum":895.47,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF NERVE LESION","code_information":[{"code":"64792","type":"CPT"}],"standard_charges":[{"minimum":1130.78,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF NERVE","code_information":[{"code":"64795","type":"CPT"}],"standard_charges":[{"minimum":203.13,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"SYMPATHECTOMY CERVICAL","code_information":[{"code":"64802","type":"CPT"}],"standard_charges":[{"minimum":896.9,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64804","type":"CPT"}],"standard_charges":[{"minimum":1258.1,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64809","type":"CPT"}],"standard_charges":[{"minimum":1149.74,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.74,"methodology":"fee schedule"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64818","type":"CPT"}],"standard_charges":[{"minimum":820.02,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.02,"methodology":"fee schedule"}]}]},{"description":"SYMPATHECTOMY DIGITAL ARTERY","code_information":[{"code":"64820","type":"CPT"}],"standard_charges":[{"minimum":811.08,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":811.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":811.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":811.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64821","type":"CPT"}],"standard_charges":[{"minimum":740.62,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64822","type":"CPT"}],"standard_charges":[{"minimum":740.62,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"SYMPATHECTOMY SUPFC PALMAR","code_information":[{"code":"64823","type":"CPT"}],"standard_charges":[{"minimum":837.54,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3492.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3561.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3544.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3458.17,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF DIGIT NERVE","code_information":[{"code":"64831","type":"CPT"}],"standard_charges":[{"minimum":734.9,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REPAIR NERVE ADD-ON","code_information":[{"code":"64832","type":"CPT"}],"standard_charges":[{"minimum":344.39,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.39,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HAND OR FOOT NERVE","code_information":[{"code":"64834","type":"CPT"}],"standard_charges":[{"minimum":786.4,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HAND OR FOOT NERVE","code_information":[{"code":"64835","type":"CPT"}],"standard_charges":[{"minimum":860.78,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF HAND OR FOOT NERVE","code_information":[{"code":"64836","type":"CPT"}],"standard_charges":[{"minimum":860.78,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR NERVE ADD-ON","code_information":[{"code":"64837","type":"CPT"}],"standard_charges":[{"minimum":375.5,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.5,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LEG NERVE","code_information":[{"code":"64840","type":"CPT"}],"standard_charges":[{"minimum":1012.77,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR/TRANSPOSE NERVE","code_information":[{"code":"64856","type":"CPT"}],"standard_charges":[{"minimum":1056.4,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARM/LEG NERVE","code_information":[{"code":"64857","type":"CPT"}],"standard_charges":[{"minimum":1104.68,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1104.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1104.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1104.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR SCIATIC NERVE","code_information":[{"code":"64858","type":"CPT"}],"standard_charges":[{"minimum":1232.35,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1232.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"NERVE SURGERY","code_information":[{"code":"64859","type":"CPT"}],"standard_charges":[{"minimum":255.34,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.34,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF ARM NERVES","code_information":[{"code":"64861","type":"CPT"}],"standard_charges":[{"minimum":1602.12,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1602.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1602.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1602.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2102.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2143.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2122.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2133.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2081.3,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF LOW BACK NERVES","code_information":[{"code":"64862","type":"CPT"}],"standard_charges":[{"minimum":1437.26,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1437.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1437.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1437.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF FACIAL NERVE","code_information":[{"code":"64864","type":"CPT"}],"standard_charges":[{"minimum":901.91,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF FACIAL NERVE","code_information":[{"code":"64865","type":"CPT"}],"standard_charges":[{"minimum":1140.44,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FACIAL/OTHER NERVE","code_information":[{"code":"64866","type":"CPT"}],"standard_charges":[{"minimum":1301.01,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1301.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1301.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1301.01,"methodology":"fee schedule"}]}]},{"description":"FUSION OF FACIAL/OTHER NERVE","code_information":[{"code":"64868","type":"CPT"}],"standard_charges":[{"minimum":1046.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.39,"methodology":"fee schedule"}]}]},{"description":"SUBSEQUENT REPAIR OF NERVE","code_information":[{"code":"64872","type":"CPT"}],"standard_charges":[{"minimum":119.44,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.44,"methodology":"fee schedule"}]}]},{"description":"REPAIR  REVISE NERVE ADD-ON","code_information":[{"code":"64874","type":"CPT"}],"standard_charges":[{"minimum":178.81,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"}]}]},{"description":"REPAIR NERVE/SHORTEN BONE","code_information":[{"code":"64876","type":"CPT"}],"standard_charges":[{"minimum":202.41,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.41,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT HEAD/NECK </4 CM","code_information":[{"code":"64885","type":"CPT"}],"standard_charges":[{"minimum":1129,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT HEAD/NECK >4 CM","code_information":[{"code":"64886","type":"CPT"}],"standard_charges":[{"minimum":1350.72,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT HAND/FOOT </4 CM","code_information":[{"code":"64890","type":"CPT"}],"standard_charges":[{"minimum":1132.22,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1132.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1132.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1132.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT HAND/FOOT >4 CM","code_information":[{"code":"64891","type":"CPT"}],"standard_charges":[{"minimum":1203.74,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT ARM/LEG <4 CM","code_information":[{"code":"64892","type":"CPT"}],"standard_charges":[{"minimum":1102.18,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1102.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1102.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1102.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT ARM/LEG >4 CM","code_information":[{"code":"64893","type":"CPT"}],"standard_charges":[{"minimum":1174.77,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT HAND/FOOT </4 CM","code_information":[{"code":"64895","type":"CPT"}],"standard_charges":[{"minimum":1385.77,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1385.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1385.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1385.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT HAND/FOOT >4 CM","code_information":[{"code":"64896","type":"CPT"}],"standard_charges":[{"minimum":1494.84,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1494.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1494.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1494.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT ARM/LEG </4 CM","code_information":[{"code":"64897","type":"CPT"}],"standard_charges":[{"minimum":1325.33,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1325.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT ARM/LEG >4 CM","code_information":[{"code":"64898","type":"CPT"}],"standard_charges":[{"minimum":1435.12,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT ADD-ON","code_information":[{"code":"64901","type":"CPT"}],"standard_charges":[{"minimum":612.96,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.96,"methodology":"fee schedule"}]}]},{"description":"NERVE GRAFT ADD-ON","code_information":[{"code":"64902","type":"CPT"}],"standard_charges":[{"minimum":709.15,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":709.15,"methodology":"fee schedule"}]}]},{"description":"NERVE PEDICLE TRANSFER","code_information":[{"code":"64905","type":"CPT"}],"standard_charges":[{"minimum":1050.68,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE PEDICLE TRANSFER","code_information":[{"code":"64907","type":"CPT"}],"standard_charges":[{"minimum":1360.02,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1360.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1360.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1360.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NERVE REPAIR W/ALLOGRAFT","code_information":[{"code":"64910","type":"CPT"}],"standard_charges":[{"minimum":802.85,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NEURORRAPHY W/VEIN AUTOGRAFT","code_information":[{"code":"64911","type":"CPT"}],"standard_charges":[{"minimum":1075,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NRV RPR W/NRV ALGRFT 1ST","code_information":[{"code":"64912","type":"CPT"}],"standard_charges":[{"minimum":940.89,"maximum":7030.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6893.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7030.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6962.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6996.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.59,"methodology":"fee schedule"}]}]},{"description":"NRV RPR W/NRV ALGRFT EA ADDL","code_information":[{"code":"64913","type":"CPT"}],"standard_charges":[{"minimum":178.81,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.81,"methodology":"fee schedule"}]}]},{"description":"NERVOUS SYSTEM SURGERY","code_information":[{"code":"64999","type":"CPT"}],"standard_charges":[{"minimum":194.08,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":317.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":324.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":320.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":322.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":314.62,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE","code_information":[{"code":"65091","type":"CPT"}],"standard_charges":[{"minimum":779.25,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE WITH IMPLANT","code_information":[{"code":"65093","type":"CPT"}],"standard_charges":[{"minimum":772.81,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EYE","code_information":[{"code":"65101","type":"CPT"}],"standard_charges":[{"minimum":891.9,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYE/INSERT IMPLANT","code_information":[{"code":"65103","type":"CPT"}],"standard_charges":[{"minimum":920.86,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":920.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":920.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":920.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYE/ATTACH IMPLANT","code_information":[{"code":"65105","type":"CPT"}],"standard_charges":[{"minimum":1001.33,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EYE","code_information":[{"code":"65110","type":"CPT"}],"standard_charges":[{"minimum":1381.47,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYE/REVISE SOCKET","code_information":[{"code":"65112","type":"CPT"}],"standard_charges":[{"minimum":1582.46,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1582.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1582.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1582.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYE/REVISE SOCKET","code_information":[{"code":"65114","type":"CPT"}],"standard_charges":[{"minimum":1651.12,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REVISE OCULAR IMPLANT","code_information":[{"code":"65125","type":"CPT"}],"standard_charges":[{"minimum":308.27,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"INSERT OCULAR IMPLANT","code_information":[{"code":"65130","type":"CPT"}],"standard_charges":[{"minimum":895.12,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"INSERT OCULAR IMPLANT","code_information":[{"code":"65135","type":"CPT"}],"standard_charges":[{"minimum":906.2,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"ATTACH OCULAR IMPLANT","code_information":[{"code":"65140","type":"CPT"}],"standard_charges":[{"minimum":973.08,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":973.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":973.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":973.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REVISE OCULAR IMPLANT","code_information":[{"code":"65150","type":"CPT"}],"standard_charges":[{"minimum":735.62,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REINSERT OCULAR IMPLANT","code_information":[{"code":"65155","type":"CPT"}],"standard_charges":[{"minimum":1012.06,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF OCULAR IMPLANT","code_information":[{"code":"65175","type":"CPT"}],"standard_charges":[{"minimum":817.15,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":817.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":817.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":817.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65205","type":"CPT"}],"standard_charges":[{"minimum":30.4,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":182.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":182.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65210","type":"CPT"}],"standard_charges":[{"minimum":37.55,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65220","type":"CPT"}],"standard_charges":[{"minimum":43.27,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65222","type":"CPT"}],"standard_charges":[{"minimum":52.57,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65235","type":"CPT"}],"standard_charges":[{"minimum":765.3,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65260","type":"CPT"}],"standard_charges":[{"minimum":1023.86,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65265","type":"CPT"}],"standard_charges":[{"minimum":1152.6,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65270","type":"CPT"}],"standard_charges":[{"minimum":146.62,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65272","type":"CPT"}],"standard_charges":[{"minimum":368.35,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65273","type":"CPT"}],"standard_charges":[{"minimum":395.88,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.88,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65275","type":"CPT"}],"standard_charges":[{"minimum":480.28,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65280","type":"CPT"}],"standard_charges":[{"minimum":698.78,"maximum":5664.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65285","type":"CPT"}],"standard_charges":[{"minimum":1151.53,"maximum":5664.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1151.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1151.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1151.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65286","type":"CPT"}],"standard_charges":[{"minimum":516.76,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EYE SOCKET WOUND","code_information":[{"code":"65290","type":"CPT"}],"standard_charges":[{"minimum":511.03,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EYE LESION","code_information":[{"code":"65400","type":"CPT"}],"standard_charges":[{"minimum":629.76,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF CORNEA","code_information":[{"code":"65410","type":"CPT"}],"standard_charges":[{"minimum":106.93,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EYE LESION","code_information":[{"code":"65420","type":"CPT"}],"standard_charges":[{"minimum":398.03,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EYE LESION","code_information":[{"code":"65426","type":"CPT"}],"standard_charges":[{"minimum":499.95,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"CORNEAL SMEAR","code_information":[{"code":"65430","type":"CPT"}],"standard_charges":[{"minimum":105.5,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":182.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":182.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"CURETTE/TREAT CORNEA","code_information":[{"code":"65435","type":"CPT"}],"standard_charges":[{"minimum":72.6,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"CURETTE/TREAT CORNEA","code_information":[{"code":"65436","type":"CPT"}],"standard_charges":[{"minimum":386.23,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF CORNEAL LESION","code_information":[{"code":"65450","type":"CPT"}],"standard_charges":[{"minimum":318.61,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":422.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":422.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"REVISION OF CORNEA","code_information":[{"code":"65600","type":"CPT"}],"standard_charges":[{"minimum":356.54,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"CORNEAL TRANSPLANT","code_information":[{"code":"65710","type":"CPT"}],"standard_charges":[{"minimum":1188.36,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"CORNEAL TRANSPLANT","code_information":[{"code":"65730","type":"CPT"}],"standard_charges":[{"minimum":1305.66,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1305.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"CORNEAL TRANSPLANT","code_information":[{"code":"65750","type":"CPT"}],"standard_charges":[{"minimum":1313.53,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1313.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1313.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1313.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"CORNEAL TRANSPLANT","code_information":[{"code":"65755","type":"CPT"}],"standard_charges":[{"minimum":1309.59,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1309.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"CORNEAL TRNSPL ENDOTHELIAL","code_information":[{"code":"65756","type":"CPT"}],"standard_charges":[{"minimum":1230.2,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1230.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1230.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1230.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"PREP CORNEAL ENDO ALLOGRAFT","code_information":[{"code":"65757","type":"CPT"}],"standard_charges":[{"minimum":155.63,"maximum":3048.53,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2286.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.63,"methodology":"fee schedule"}]}]},{"description":"REVISE CORNEA WITH IMPLANT","code_information":[{"code":"65770","type":"CPT"}],"standard_charges":[{"minimum":1465.51,"maximum":26096.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26096.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19575.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19575.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9912,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1465.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1465.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1465.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15382.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15686.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15534.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15610.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.83,"methodology":"fee schedule"}]}]},{"description":"CORRECTION OF ASTIGMATISM","code_information":[{"code":"65772","type":"CPT"}],"standard_charges":[{"minimum":423.78,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"CORRECTION OF ASTIGMATISM","code_information":[{"code":"65775","type":"CPT"}],"standard_charges":[{"minimum":600.08,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"COVER EYE W/MEMBRANE","code_information":[{"code":"65778","type":"CPT"}],"standard_charges":[{"minimum":45.77,"maximum":4392.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"COVER EYE W/MEMBRANE SUTURE","code_information":[{"code":"65779","type":"CPT"}],"standard_charges":[{"minimum":122.66,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"OCULAR RECONST TRANSPLANT","code_information":[{"code":"65780","type":"CPT"}],"standard_charges":[{"minimum":617.96,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"OCULAR RECONST TRANSPLANT","code_information":[{"code":"65781","type":"CPT"}],"standard_charges":[{"minimum":1381.47,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"OCULAR RECONST TRANSPLANT","code_information":[{"code":"65782","type":"CPT"}],"standard_charges":[{"minimum":1193.37,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1193.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1193.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1193.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"IMPLTJ NTRSTRML CRNL RNG SEG","code_information":[{"code":"65785","type":"CPT"}],"standard_charges":[{"minimum":463.47,"maximum":10323.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10323.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7743.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7743.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF EYE","code_information":[{"code":"65800","type":"CPT"}],"standard_charges":[{"minimum":92.62,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF EYE","code_information":[{"code":"65810","type":"CPT"}],"standard_charges":[{"minimum":485.29,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF EYE","code_information":[{"code":"65815","type":"CPT"}],"standard_charges":[{"minimum":497.8,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"RELIEVE INNER EYE PRESSURE","code_information":[{"code":"65820","type":"CPT"}],"standard_charges":[{"minimum":860.43,"maximum":7907.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7907.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"INCISION OF EYE","code_information":[{"code":"65850","type":"CPT"}],"standard_charges":[{"minimum":879.38,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"TRABECULOPLASTY LASER SURG","code_information":[{"code":"65855","type":"CPT"}],"standard_charges":[{"minimum":213.85,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65860","type":"CPT"}],"standard_charges":[{"minimum":259.27,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65865","type":"CPT"}],"standard_charges":[{"minimum":499.95,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65870","type":"CPT"}],"standard_charges":[{"minimum":620.82,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65875","type":"CPT"}],"standard_charges":[{"minimum":663.02,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65880","type":"CPT"}],"standard_charges":[{"minimum":696.28,"maximum":4416.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYE LESION","code_information":[{"code":"65900","type":"CPT"}],"standard_charges":[{"minimum":1034.23,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVE IMPLANT OF EYE","code_information":[{"code":"65920","type":"CPT"}],"standard_charges":[{"minimum":826.81,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVE BLOOD CLOT FROM EYE","code_information":[{"code":"65930","type":"CPT"}],"standard_charges":[{"minimum":670.17,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF EYE","code_information":[{"code":"66020","type":"CPT"}],"standard_charges":[{"minimum":137.32,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"INJECTION TREATMENT OF EYE","code_information":[{"code":"66030","type":"CPT"}],"standard_charges":[{"minimum":116.58,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYE LESION","code_information":[{"code":"66130","type":"CPT"}],"standard_charges":[{"minimum":588.64,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":588.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":588.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":588.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"GLAUCOMA SURGERY","code_information":[{"code":"66150","type":"CPT"}],"standard_charges":[{"minimum":916.93,"maximum":4416.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"GLAUCOMA SURGERY","code_information":[{"code":"66155","type":"CPT"}],"standard_charges":[{"minimum":916.57,"maximum":4416.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"GLAUCOMA SURGERY","code_information":[{"code":"66160","type":"CPT"}],"standard_charges":[{"minimum":1029.94,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"GLAUCOMA SURGERY","code_information":[{"code":"66170","type":"CPT"}],"standard_charges":[{"minimum":1142.23,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"INCISION OF EYE","code_information":[{"code":"66172","type":"CPT"}],"standard_charges":[{"minimum":1247.37,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"TRANSLUM DIL EYE CANAL","code_information":[{"code":"66174","type":"CPT"}],"standard_charges":[{"minimum":651.58,"maximum":7907.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7907.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":651.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":651.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":651.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"TRNSLUM DIL EYE CANAL W/STNT","code_information":[{"code":"66175","type":"CPT"}],"standard_charges":[{"minimum":756.72,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"AQUEOUS SHUNT EYE W/O GRAFT","code_information":[{"code":"66179","type":"CPT"}],"standard_charges":[{"minimum":1127.92,"maximum":7907.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7907.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1127.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"AQUEOUS SHUNT EYE W/GRAFT","code_information":[{"code":"66180","type":"CPT"}],"standard_charges":[{"minimum":1188.36,"maximum":7907.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7907.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"INSERT ANT DRAINAGE DEVICE","code_information":[{"code":"66183","type":"CPT"}],"standard_charges":[{"minimum":1075,"maximum":7907.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7907.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"REVISION OF AQUEOUS SHUNT","code_information":[{"code":"66184","type":"CPT"}],"standard_charges":[{"minimum":827.53,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REVISE AQUEOUS SHUNT EYE","code_information":[{"code":"66185","type":"CPT"}],"standard_charges":[{"minimum":888.32,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR/GRAFT EYE LESION","code_information":[{"code":"66225","type":"CPT"}],"standard_charges":[{"minimum":975.94,"maximum":5664.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"FOLLOW-UP SURGERY OF EYE","code_information":[{"code":"66250","type":"CPT"}],"standard_charges":[{"minimum":581.13,"maximum":4040.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4040.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3030.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3030.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"INCISION OF IRIS","code_information":[{"code":"66500","type":"CPT"}],"standard_charges":[{"minimum":413.05,"maximum":2503.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"INCISION OF IRIS","code_information":[{"code":"66505","type":"CPT"}],"standard_charges":[{"minimum":449.52,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVE IRIS AND LESION","code_information":[{"code":"66600","type":"CPT"}],"standard_charges":[{"minimum":945.54,"maximum":4416.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":945.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":945.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":945.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF IRIS","code_information":[{"code":"66605","type":"CPT"}],"standard_charges":[{"minimum":1135.79,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF IRIS","code_information":[{"code":"66625","type":"CPT"}],"standard_charges":[{"minimum":448.09,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF IRIS","code_information":[{"code":"66630","type":"CPT"}],"standard_charges":[{"minimum":592.21,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":592.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":592.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":592.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF IRIS","code_information":[{"code":"66635","type":"CPT"}],"standard_charges":[{"minimum":597.58,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR IRIS  CILIARY BODY","code_information":[{"code":"66680","type":"CPT"}],"standard_charges":[{"minimum":544.65,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR IRIS  CILIARY BODY","code_information":[{"code":"66682","type":"CPT"}],"standard_charges":[{"minimum":744.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION CILIARY BODY","code_information":[{"code":"66700","type":"CPT"}],"standard_charges":[{"minimum":409.11,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"CILIARY TRANSSLERAL THERAPY","code_information":[{"code":"66710","type":"CPT"}],"standard_charges":[{"minimum":408.76,"maximum":4040.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4040.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3030.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3030.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"ECP CILIARY BODY DESTRUCTION","code_information":[{"code":"66711","type":"CPT"}],"standard_charges":[{"minimum":529.63,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION CILIARY BODY","code_information":[{"code":"66720","type":"CPT"}],"standard_charges":[{"minimum":430.57,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION CILIARY BODY","code_information":[{"code":"66740","type":"CPT"}],"standard_charges":[{"minimum":409.11,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISION OF IRIS","code_information":[{"code":"66761","type":"CPT"}],"standard_charges":[{"minimum":246.76,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"REVISION OF IRIS","code_information":[{"code":"66762","type":"CPT"}],"standard_charges":[{"minimum":443.45,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF INNER EYE LESION","code_information":[{"code":"66770","type":"CPT"}],"standard_charges":[{"minimum":502.81,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"INCISION SECONDARY CATARACT","code_information":[{"code":"66820","type":"CPT"}],"standard_charges":[{"minimum":490.65,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"AFTER CATARACT LASER SURGERY","code_information":[{"code":"66821","type":"CPT"}],"standard_charges":[{"minimum":325.79,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"REPOSITION INTRAOCULAR LENS","code_information":[{"code":"66825","type":"CPT"}],"standard_charges":[{"minimum":870.44,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LENS LESION","code_information":[{"code":"66830","type":"CPT"}],"standard_charges":[{"minimum":740.27,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LENS MATERIAL","code_information":[{"code":"66840","type":"CPT"}],"standard_charges":[{"minimum":722.74,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LENS MATERIAL","code_information":[{"code":"66850","type":"CPT"}],"standard_charges":[{"minimum":821.8,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF LENS MATERIAL","code_information":[{"code":"66852","type":"CPT"}],"standard_charges":[{"minimum":874.02,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"EXTRACTION OF LENS","code_information":[{"code":"66920","type":"CPT"}],"standard_charges":[{"minimum":780.32,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"EXTRACTION OF LENS","code_information":[{"code":"66930","type":"CPT"}],"standard_charges":[{"minimum":893.33,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"EXTRACTION OF LENS","code_information":[{"code":"66940","type":"CPT"}],"standard_charges":[{"minimum":818.23,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":818.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"XCAPSL CTRC RMVL CPLX WO ECP","code_information":[{"code":"66982","type":"CPT"}],"standard_charges":[{"minimum":776.74,"maximum":6215,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5749.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4312.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4312.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6215,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6215,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"CATARACT SURG W/IOL 1 STAGE","code_information":[{"code":"66983","type":"CPT"}],"standard_charges":[{"minimum":753.6,"maximum":6215,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5962.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4472.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4472.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6215,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6215,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"XCAPSL CTRC RMVL W/O ECP","code_information":[{"code":"66984","type":"CPT"}],"standard_charges":[{"minimum":566.82,"maximum":6215,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5749.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4312.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4312.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6215,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6215,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"INSERT LENS PROSTHESIS","code_information":[{"code":"66985","type":"CPT"}],"standard_charges":[{"minimum":802.49,"maximum":5223,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5061.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3796.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3796.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4378,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4378,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"EXCHANGE LENS PROSTHESIS","code_information":[{"code":"66986","type":"CPT"}],"standard_charges":[{"minimum":940.18,"maximum":5223,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5061.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3796.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3796.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4378,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4378,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"XCAPSL CTRC RMVL CPLX W/ECP","code_information":[{"code":"66987","type":"CPT"}],"standard_charges":[{"minimum":2911.37,"maximum":7907.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7907.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"XCAPSL CTRC RMVL W/ECP","code_information":[{"code":"66988","type":"CPT"}],"standard_charges":[{"minimum":2911.37,"maximum":7907.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5223,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7907.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5931.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"OPHTHALMIC ENDOSCOPE ADD-ON","code_information":[{"code":"66990","type":"CPT"}],"standard_charges":[{"minimum":91.55,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"}]}]},{"description":"EYE SURGERY PROCEDURE","code_information":[{"code":"66999","type":"CPT"}],"standard_charges":[{"minimum":1545.07,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1545.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1545.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1545.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF EYE FLUID","code_information":[{"code":"67005","type":"CPT"}],"standard_charges":[{"minimum":498.88,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF EYE FLUID","code_information":[{"code":"67010","type":"CPT"}],"standard_charges":[{"minimum":570.04,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF EYE FLUID","code_information":[{"code":"67015","type":"CPT"}],"standard_charges":[{"minimum":631.55,"maximum":4192.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3145.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REPLACE EYE FLUID","code_information":[{"code":"67025","type":"CPT"}],"standard_charges":[{"minimum":658.02,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"IMPLANT EYE DRUG SYSTEM","code_information":[{"code":"67027","type":"CPT"}],"standard_charges":[{"minimum":882.6,"maximum":16867.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16376.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16539.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16867.43,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16703.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16376.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16376.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16376.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16785.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16376.14,"methodology":"fee schedule"}]}]},{"description":"INJECTION EYE DRUG","code_information":[{"code":"67028","type":"CPT"}],"standard_charges":[{"minimum":95.13,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":364.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":360.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":362.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EYE STRANDS","code_information":[{"code":"67030","type":"CPT"}],"standard_charges":[{"minimum":583.27,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"LASER SURGERY EYE STRANDS","code_information":[{"code":"67031","type":"CPT"}],"standard_charges":[{"minimum":369.06,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF INNER EYE FLUID","code_information":[{"code":"67036","type":"CPT"}],"standard_charges":[{"minimum":933.74,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"LASER TREATMENT OF RETINA","code_information":[{"code":"67039","type":"CPT"}],"standard_charges":[{"minimum":998.82,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":998.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":998.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":998.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"LASER TREATMENT OF RETINA","code_information":[{"code":"67040","type":"CPT"}],"standard_charges":[{"minimum":1077.86,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6151.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4614.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4614.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"VIT FOR MACULAR PUCKER","code_information":[{"code":"67041","type":"CPT"}],"standard_charges":[{"minimum":1188,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6472.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4854.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4854.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"VIT FOR MACULAR HOLE","code_information":[{"code":"67042","type":"CPT"}],"standard_charges":[{"minimum":1188,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6289.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4717.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4717.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1188,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"VIT FOR MEMBRANE DISSECT","code_information":[{"code":"67043","type":"CPT"}],"standard_charges":[{"minimum":1252.73,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"REPAIR DETACHED RETINA CRTX","code_information":[{"code":"67101","type":"CPT"}],"standard_charges":[{"minimum":297.18,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR DETACHED RETINA PC","code_information":[{"code":"67105","type":"CPT"}],"standard_charges":[{"minimum":286.81,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"REPAIR DETACHED RETINA","code_information":[{"code":"67107","type":"CPT"}],"standard_charges":[{"minimum":1167.98,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"REPAIR DETACHED RETINA","code_information":[{"code":"67108","type":"CPT"}],"standard_charges":[{"minimum":1236.28,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1236.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1236.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1236.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"REPAIR DETACHED RETINA","code_information":[{"code":"67110","type":"CPT"}],"standard_charges":[{"minimum":848.63,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REPAIR RETINAL DETACH CPLX","code_information":[{"code":"67113","type":"CPT"}],"standard_charges":[{"minimum":1381.83,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6100.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4576.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4576.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5554.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5664.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5609.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5636.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5499.32,"methodology":"fee schedule"}]}]},{"description":"RELEASE ENCIRCLING MATERIAL","code_information":[{"code":"67115","type":"CPT"}],"standard_charges":[{"minimum":521.05,"maximum":4416.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYE IMPLANT MATERIAL","code_information":[{"code":"67120","type":"CPT"}],"standard_charges":[{"minimum":579.34,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYE IMPLANT MATERIAL","code_information":[{"code":"67121","type":"CPT"}],"standard_charges":[{"minimum":941.25,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":941.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF RETINA","code_information":[{"code":"67141","type":"CPT"}],"standard_charges":[{"minimum":226.37,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF RETINA","code_information":[{"code":"67145","type":"CPT"}],"standard_charges":[{"minimum":226.37,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF RETINAL LESION","code_information":[{"code":"67208","type":"CPT"}],"standard_charges":[{"minimum":318.61,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF RETINAL LESION","code_information":[{"code":"67210","type":"CPT"}],"standard_charges":[{"minimum":519.98,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF RETINAL LESION","code_information":[{"code":"67218","type":"CPT"}],"standard_charges":[{"minimum":1445.85,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1445.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1445.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1445.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF CHOROID LESION","code_information":[{"code":"67220","type":"CPT"}],"standard_charges":[{"minimum":519.98,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"OCULAR PHOTODYNAMIC THER","code_information":[{"code":"67221","type":"CPT"}],"standard_charges":[{"minimum":216,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"EYE PHOTODYNAMIC THER ADD-ON","code_information":[{"code":"67225","type":"CPT"}],"standard_charges":[{"minimum":28.61,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"}]}]},{"description":"DSTRJ EXTENSIVE RETINOPATHY","code_information":[{"code":"67227","type":"CPT"}],"standard_charges":[{"minimum":265.35,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"TREATMENT X10SV RETINOPATHY","code_information":[{"code":"67228","type":"CPT"}],"standard_charges":[{"minimum":315.42,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"TR RETINAL LES PRETERM INF","code_information":[{"code":"67229","type":"CPT"}],"standard_charges":[{"minimum":584.71,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":602.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.71,"methodology":"fee schedule"}]}]},{"description":"REINFORCE EYE WALL","code_information":[{"code":"67250","type":"CPT"}],"standard_charges":[{"minimum":946.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REINFORCE/GRAFT EYE WALL","code_information":[{"code":"67255","type":"CPT"}],"standard_charges":[{"minimum":719.88,"maximum":4416.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4330.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4416.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4373.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4394.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4287.64,"methodology":"fee schedule"}]}]},{"description":"EYE SURGERY PROCEDURE","code_information":[{"code":"67299","type":"CPT"}],"standard_charges":[{"minimum":1545.07,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1545.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1545.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1545.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE MUSCLE","code_information":[{"code":"67311","type":"CPT"}],"standard_charges":[{"minimum":475.63,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE TWO EYE MUSCLES","code_information":[{"code":"67312","type":"CPT"}],"standard_charges":[{"minimum":692.7,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE MUSCLE","code_information":[{"code":"67314","type":"CPT"}],"standard_charges":[{"minimum":475.63,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE TWO EYE MUSCLES","code_information":[{"code":"67316","type":"CPT"}],"standard_charges":[{"minimum":742.41,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE MUSCLE(S)","code_information":[{"code":"67318","type":"CPT"}],"standard_charges":[{"minimum":718.09,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE MUSCLE(S) ADD-ON","code_information":[{"code":"67320","type":"CPT"}],"standard_charges":[{"minimum":181.31,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"}]}]},{"description":"EYE SURGERY FOLLOW-UP ADD-ON","code_information":[{"code":"67331","type":"CPT"}],"standard_charges":[{"minimum":162,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"}]}]},{"description":"REREVISE EYE MUSCLES ADD-ON","code_information":[{"code":"67332","type":"CPT"}],"standard_charges":[{"minimum":210.99,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE MUSCLE W/SUTURE","code_information":[{"code":"67334","type":"CPT"}],"standard_charges":[{"minimum":159.5,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.5,"methodology":"fee schedule"}]}]},{"description":"EYE SUTURE DURING SURGERY","code_information":[{"code":"67335","type":"CPT"}],"standard_charges":[{"minimum":193.47,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.47,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE MUSCLE ADD-ON","code_information":[{"code":"67340","type":"CPT"}],"standard_charges":[{"minimum":302.54,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1450.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"}]}]},{"description":"RELEASE EYE TISSUE","code_information":[{"code":"67343","type":"CPT"}],"standard_charges":[{"minimum":703.43,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"DESTROY NERVE OF EYE MUSCLE","code_information":[{"code":"67345","type":"CPT"}],"standard_charges":[{"minimum":225.3,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"BIOPSY EYE MUSCLE","code_information":[{"code":"67346","type":"CPT"}],"standard_charges":[{"minimum":200.27,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"UNLISTED PX EXTRAOCULAR MUSC","code_information":[{"code":"67399","type":"CPT"}],"standard_charges":[{"minimum":194.17,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/BIOPSY EYE SOCKET","code_information":[{"code":"67400","type":"CPT"}],"standard_charges":[{"minimum":1085.01,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1085.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1085.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1085.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/DRAIN EYE SOCKET","code_information":[{"code":"67405","type":"CPT"}],"standard_charges":[{"minimum":948.4,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT EYE SOCKET","code_information":[{"code":"67412","type":"CPT"}],"standard_charges":[{"minimum":1034.94,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT EYE SOCKET","code_information":[{"code":"67413","type":"CPT"}],"standard_charges":[{"minimum":1008.48,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"EXPLR/DECOMPRESS EYE SOCKET","code_information":[{"code":"67414","type":"CPT"}],"standard_charges":[{"minimum":1518.08,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1518.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"ASPIRATION ORBITAL CONTENTS","code_information":[{"code":"67415","type":"CPT"}],"standard_charges":[{"minimum":106.57,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT EYE SOCKET","code_information":[{"code":"67420","type":"CPT"}],"standard_charges":[{"minimum":1813.48,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1813.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1813.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1813.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/TREAT EYE SOCKET","code_information":[{"code":"67430","type":"CPT"}],"standard_charges":[{"minimum":1449.78,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1449.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1449.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1449.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/DRAIN EYE SOCKET","code_information":[{"code":"67440","type":"CPT"}],"standard_charges":[{"minimum":1406.51,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"EXPLR/DECOMPRESS EYE SOCKET","code_information":[{"code":"67445","type":"CPT"}],"standard_charges":[{"minimum":1596.4,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/BIOPSY EYE SOCKET","code_information":[{"code":"67450","type":"CPT"}],"standard_charges":[{"minimum":1456.93,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"INJECT/TREAT EYE SOCKET","code_information":[{"code":"67500","type":"CPT"}],"standard_charges":[{"minimum":67.23,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"INJECT/TREAT EYE SOCKET","code_information":[{"code":"67505","type":"CPT"}],"standard_charges":[{"minimum":75.1,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"INJECT/TREAT EYE SOCKET","code_information":[{"code":"67515","type":"CPT"}],"standard_charges":[{"minimum":48.99,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"INSERT EYE SOCKET IMPLANT","code_information":[{"code":"67550","type":"CPT"}],"standard_charges":[{"minimum":1134.72,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REVISE EYE SOCKET IMPLANT","code_information":[{"code":"67560","type":"CPT"}],"standard_charges":[{"minimum":1160.11,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"DECOMPRESS OPTIC NERVE","code_information":[{"code":"67570","type":"CPT"}],"standard_charges":[{"minimum":1331.05,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1331.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"ORBIT SURGERY PROCEDURE","code_information":[{"code":"67599","type":"CPT"}],"standard_charges":[{"minimum":194.17,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"DRAINAGE OF EYELID ABSCESS","code_information":[{"code":"67700","type":"CPT"}],"standard_charges":[{"minimum":121.59,"maximum":3863.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"INCISION OF EYELID","code_information":[{"code":"67710","type":"CPT"}],"standard_charges":[{"minimum":102.64,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"INCISION OF EYELID FOLD","code_information":[{"code":"67715","type":"CPT"}],"standard_charges":[{"minimum":112.29,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LESION","code_information":[{"code":"67800","type":"CPT"}],"standard_charges":[{"minimum":106.93,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LESIONS","code_information":[{"code":"67801","type":"CPT"}],"standard_charges":[{"minimum":136.97,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LESIONS","code_information":[{"code":"67805","type":"CPT"}],"standard_charges":[{"minimum":170.23,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LESION(S)","code_information":[{"code":"67808","type":"CPT"}],"standard_charges":[{"minimum":384.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"BIOPSY EYELID  LID MARGIN","code_information":[{"code":"67810","type":"CPT"}],"standard_charges":[{"minimum":70.81,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELASHES","code_information":[{"code":"67820","type":"CPT"}],"standard_charges":[{"minimum":23.25,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELASHES","code_information":[{"code":"67825","type":"CPT"}],"standard_charges":[{"minimum":127.67,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELASHES","code_information":[{"code":"67830","type":"CPT"}],"standard_charges":[{"minimum":143.4,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELASHES","code_information":[{"code":"67835","type":"CPT"}],"standard_charges":[{"minimum":460.61,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LESION","code_information":[{"code":"67840","type":"CPT"}],"standard_charges":[{"minimum":163.79,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"TREAT EYELID LESION","code_information":[{"code":"67850","type":"CPT"}],"standard_charges":[{"minimum":137.32,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF EYELID BY SUTURE","code_information":[{"code":"67875","type":"CPT"}],"standard_charges":[{"minimum":99.78,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67880","type":"CPT"}],"standard_charges":[{"minimum":384.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67882","type":"CPT"}],"standard_charges":[{"minimum":491.37,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR BROW DEFECT","code_information":[{"code":"67900","type":"CPT"}],"standard_charges":[{"minimum":527.13,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67901","type":"CPT"}],"standard_charges":[{"minimum":615.1,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67902","type":"CPT"}],"standard_charges":[{"minimum":756.36,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67903","type":"CPT"}],"standard_charges":[{"minimum":500.66,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67904","type":"CPT"}],"standard_charges":[{"minimum":620.82,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67906","type":"CPT"}],"standard_charges":[{"minimum":526.05,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67908","type":"CPT"}],"standard_charges":[{"minimum":451.31,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELID DEFECT","code_information":[{"code":"67909","type":"CPT"}],"standard_charges":[{"minimum":456.68,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELID DEFECT","code_information":[{"code":"67911","type":"CPT"}],"standard_charges":[{"minimum":583.63,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"CORRECTION EYELID W/IMPLANT","code_information":[{"code":"67912","type":"CPT"}],"standard_charges":[{"minimum":506.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67914","type":"CPT"}],"standard_charges":[{"minimum":344.74,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67915","type":"CPT"}],"standard_charges":[{"minimum":209.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67916","type":"CPT"}],"standard_charges":[{"minimum":448.45,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67917","type":"CPT"}],"standard_charges":[{"minimum":475.99,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67921","type":"CPT"}],"standard_charges":[{"minimum":327.22,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67922","type":"CPT"}],"standard_charges":[{"minimum":209.56,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67923","type":"CPT"}],"standard_charges":[{"minimum":448.81,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67924","type":"CPT"}],"standard_charges":[{"minimum":475.99,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID WOUND","code_information":[{"code":"67930","type":"CPT"}],"standard_charges":[{"minimum":245.68,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REPAIR EYELID WOUND","code_information":[{"code":"67935","type":"CPT"}],"standard_charges":[{"minimum":456.32,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID FOREIGN BODY","code_information":[{"code":"67938","type":"CPT"}],"standard_charges":[{"minimum":123.38,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67950","type":"CPT"}],"standard_charges":[{"minimum":482.07,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67961","type":"CPT"}],"standard_charges":[{"minimum":473.84,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67966","type":"CPT"}],"standard_charges":[{"minimum":681.26,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF EYELID","code_information":[{"code":"67971","type":"CPT"}],"standard_charges":[{"minimum":748.49,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF EYELID","code_information":[{"code":"67973","type":"CPT"}],"standard_charges":[{"minimum":962.7,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF EYELID","code_information":[{"code":"67974","type":"CPT"}],"standard_charges":[{"minimum":960.56,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"RECONSTRUCTION OF EYELID","code_information":[{"code":"67975","type":"CPT"}],"standard_charges":[{"minimum":708.8,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67999","type":"CPT"}],"standard_charges":[{"minimum":194.17,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"INCISE/DRAIN EYELID LINING","code_information":[{"code":"68020","type":"CPT"}],"standard_charges":[{"minimum":115.15,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"TREATMENT OF EYELID LESIONS","code_information":[{"code":"68040","type":"CPT"}],"standard_charges":[{"minimum":49.71,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF EYELID LINING","code_information":[{"code":"68100","type":"CPT"}],"standard_charges":[{"minimum":99.42,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LINING LESION","code_information":[{"code":"68110","type":"CPT"}],"standard_charges":[{"minimum":155.21,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LINING LESION","code_information":[{"code":"68115","type":"CPT"}],"standard_charges":[{"minimum":190.97,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LINING LESION","code_information":[{"code":"68130","type":"CPT"}],"standard_charges":[{"minimum":431.64,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE EYELID LINING LESION","code_information":[{"code":"68135","type":"CPT"}],"standard_charges":[{"minimum":156.28,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"TREAT EYELID BY INJECTION","code_information":[{"code":"68200","type":"CPT"}],"standard_charges":[{"minimum":35.4,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68320","type":"CPT"}],"standard_charges":[{"minimum":563.96,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":563.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":563.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":563.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68325","type":"CPT"}],"standard_charges":[{"minimum":684.12,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68326","type":"CPT"}],"standard_charges":[{"minimum":671.96,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68328","type":"CPT"}],"standard_charges":[{"minimum":733.47,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELID LINING","code_information":[{"code":"68330","type":"CPT"}],"standard_charges":[{"minimum":480.64,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2455.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2503.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2479.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2491.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2430.85,"methodology":"fee schedule"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68335","type":"CPT"}],"standard_charges":[{"minimum":673.75,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"SEPARATE EYELID ADHESIONS","code_information":[{"code":"68340","type":"CPT"}],"standard_charges":[{"minimum":415.19,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELID LINING","code_information":[{"code":"68360","type":"CPT"}],"standard_charges":[{"minimum":428.78,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REVISE EYELID LINING","code_information":[{"code":"68362","type":"CPT"}],"standard_charges":[{"minimum":683.05,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"HARVEST EYE TISSUE ALOGRAFT","code_information":[{"code":"68371","type":"CPT"}],"standard_charges":[{"minimum":430.57,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"EYELID LINING SURGERY","code_information":[{"code":"68399","type":"CPT"}],"standard_charges":[{"minimum":194.17,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"INCISE/DRAIN TEAR GLAND","code_information":[{"code":"68400","type":"CPT"}],"standard_charges":[{"minimum":137.32,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1042.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1063.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1052.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1058.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1032.29,"methodology":"fee schedule"}]}]},{"description":"INCISE/DRAIN TEAR SAC","code_information":[{"code":"68420","type":"CPT"}],"standard_charges":[{"minimum":173.8,"maximum":3426,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"INCISE TEAR DUCT OPENING","code_information":[{"code":"68440","type":"CPT"}],"standard_charges":[{"minimum":105.14,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TEAR GLAND","code_information":[{"code":"68500","type":"CPT"}],"standard_charges":[{"minimum":1110.4,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL TEAR GLAND","code_information":[{"code":"68505","type":"CPT"}],"standard_charges":[{"minimum":1105.75,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF TEAR GLAND","code_information":[{"code":"68510","type":"CPT"}],"standard_charges":[{"minimum":298.25,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF TEAR SAC","code_information":[{"code":"68520","type":"CPT"}],"standard_charges":[{"minimum":772.1,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF TEAR SAC","code_information":[{"code":"68525","type":"CPT"}],"standard_charges":[{"minimum":267.14,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"CLEARANCE OF TEAR DUCT","code_information":[{"code":"68530","type":"CPT"}],"standard_charges":[{"minimum":264.64,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"REMOVE TEAR GLAND LESION","code_information":[{"code":"68540","type":"CPT"}],"standard_charges":[{"minimum":1028.15,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REMOVE TEAR GLAND LESION","code_information":[{"code":"68550","type":"CPT"}],"standard_charges":[{"minimum":1279.55,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"REPAIR TEAR DUCTS","code_information":[{"code":"68700","type":"CPT"}],"standard_charges":[{"minimum":628.33,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"REVISE TEAR DUCT OPENING","code_information":[{"code":"68705","type":"CPT"}],"standard_charges":[{"minimum":173.09,"maximum":3127.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"CREATE TEAR SAC DRAIN","code_information":[{"code":"68720","type":"CPT"}],"standard_charges":[{"minimum":847.19,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"CREATE TEAR DUCT DRAIN","code_information":[{"code":"68745","type":"CPT"}],"standard_charges":[{"minimum":851.84,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"CREATE TEAR DUCT DRAIN","code_information":[{"code":"68750","type":"CPT"}],"standard_charges":[{"minimum":899.76,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":899.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":899.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":899.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4059.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4139.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4099.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4119.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4019.21,"methodology":"fee schedule"}]}]},{"description":"CLOSE TEAR DUCT OPENING","code_information":[{"code":"68760","type":"CPT"}],"standard_charges":[{"minimum":152.7,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"CLOSE TEAR DUCT OPENING","code_information":[{"code":"68761","type":"CPT"}],"standard_charges":[{"minimum":122.66,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"CLOSE TEAR SYSTEM FISTULA","code_information":[{"code":"68770","type":"CPT"}],"standard_charges":[{"minimum":653.37,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"DILATE TEAR DUCT OPENING","code_information":[{"code":"68801","type":"CPT"}],"standard_charges":[{"minimum":83.32,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":182.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":182.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":429.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":433.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":435.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.3,"methodology":"fee schedule"}]}]},{"description":"PROBE NASOLACRIMAL DUCT","code_information":[{"code":"68810","type":"CPT"}],"standard_charges":[{"minimum":133.75,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":422.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":422.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"PROBE NASOLACRIMAL DUCT","code_information":[{"code":"68811","type":"CPT"}],"standard_charges":[{"minimum":140.9,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"PROBE NASOLACRIMAL DUCT","code_information":[{"code":"68815","type":"CPT"}],"standard_charges":[{"minimum":232.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"PROBE NL DUCT W/BALLOON","code_information":[{"code":"68816","type":"CPT"}],"standard_charges":[{"minimum":164.15,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2511.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2561.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2536.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2548.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2486.52,"methodology":"fee schedule"}]}]},{"description":"EXPLORE/IRRIGATE TEAR DUCTS","code_information":[{"code":"68840","type":"CPT"}],"standard_charges":[{"minimum":122.66,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR TEAR SAC X-RAY","code_information":[{"code":"68850","type":"CPT"}],"standard_charges":[{"minimum":53.64,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":203.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":203.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"}]}]},{"description":"TEAR DUCT SYSTEM SURGERY","code_information":[{"code":"68899","type":"CPT"}],"standard_charges":[{"minimum":194.17,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":321.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":328.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":324.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":326.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":318.61,"methodology":"fee schedule"}]}]},{"description":"DRAIN EXTERNAL EAR LESION","code_information":[{"code":"69000","type":"CPT"}],"standard_charges":[{"minimum":132.68,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"DRAIN EXTERNAL EAR LESION","code_information":[{"code":"69005","type":"CPT"}],"standard_charges":[{"minimum":170.94,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"DRAIN OUTER EAR CANAL LESION","code_information":[{"code":"69020","type":"CPT"}],"standard_charges":[{"minimum":152.34,"maximum":2594,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2554,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2017,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":757.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":772.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":764.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":768.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":749.9,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF EXTERNAL EAR","code_information":[{"code":"69100","type":"CPT"}],"standard_charges":[{"minimum":48.28,"maximum":2053,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF EXTERNAL EAR CANAL","code_information":[{"code":"69105","type":"CPT"}],"standard_charges":[{"minimum":67.23,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVE EXTERNAL EAR PARTIAL","code_information":[{"code":"69110","type":"CPT"}],"standard_charges":[{"minimum":346.53,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF EXTERNAL EAR","code_information":[{"code":"69120","type":"CPT"}],"standard_charges":[{"minimum":409.47,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE EAR CANAL LESION(S)","code_information":[{"code":"69140","type":"CPT"}],"standard_charges":[{"minimum":950.9,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":950.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":950.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":950.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE EAR CANAL LESION(S)","code_information":[{"code":"69145","type":"CPT"}],"standard_charges":[{"minimum":272.86,"maximum":3141.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3080.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3141.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3111.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3126.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3050.43,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE EAR CANAL SURGERY","code_information":[{"code":"69150","type":"CPT"}],"standard_charges":[{"minimum":1060.33,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1060.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE EAR/NECK SURGERY","code_information":[{"code":"69155","type":"CPT"}],"standard_charges":[{"minimum":1714.42,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.42,"methodology":"fee schedule"}]}]},{"description":"CLEAR OUTER EAR CANAL","code_information":[{"code":"69200","type":"CPT"}],"standard_charges":[{"minimum":49.71,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"CLEAR OUTER EAR CANAL","code_information":[{"code":"69205","type":"CPT"}],"standard_charges":[{"minimum":100.85,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1744.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1778.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1761.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1726.88,"methodology":"fee schedule"}]}]},{"description":"REMOVE IMPACTED EAR WAX UNI","code_information":[{"code":"69209","type":"CPT"}],"standard_charges":[{"minimum":16.81,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"REMOVE IMPACTED EAR WAX UNI","code_information":[{"code":"69210","type":"CPT"}],"standard_charges":[{"minimum":33.97,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"CLEAN OUT MASTOID CAVITY","code_information":[{"code":"69220","type":"CPT"}],"standard_charges":[{"minimum":54,"maximum":1919,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"CLEAN OUT MASTOID CAVITY","code_information":[{"code":"69222","type":"CPT"}],"standard_charges":[{"minimum":144.83,"maximum":2788,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"REVISE EXTERNAL EAR","code_information":[{"code":"69300","type":"CPT"}],"standard_charges":[{"minimum":497.45,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REBUILD OUTER EAR CANAL","code_information":[{"code":"69310","type":"CPT"}],"standard_charges":[{"minimum":1175.49,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REBUILD OUTER EAR CANAL","code_information":[{"code":"69320","type":"CPT"}],"standard_charges":[{"minimum":1640.75,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1640.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"OUTER EAR SURGERY PROCEDURE","code_information":[{"code":"69399","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2040.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"INCISION OF EARDRUM","code_information":[{"code":"69420","type":"CPT"}],"standard_charges":[{"minimum":128.03,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"INCISION OF EARDRUM","code_information":[{"code":"69421","type":"CPT"}],"standard_charges":[{"minimum":160.57,"maximum":3560.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVE VENTILATING TUBE","code_information":[{"code":"69424","type":"CPT"}],"standard_charges":[{"minimum":63.66,"maximum":6477,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"CREATE EARDRUM OPENING","code_information":[{"code":"69433","type":"CPT"}],"standard_charges":[{"minimum":140.54,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":559.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":553.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":556.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":542.77,"methodology":"fee schedule"}]}]},{"description":"CREATE EARDRUM OPENING","code_information":[{"code":"69436","type":"CPT"}],"standard_charges":[{"minimum":169.15,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXPLORATION OF MIDDLE EAR","code_information":[{"code":"69440","type":"CPT"}],"standard_charges":[{"minimum":732.04,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"EARDRUM REVISION","code_information":[{"code":"69450","type":"CPT"}],"standard_charges":[{"minimum":579.7,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"MASTOIDECTOMY","code_information":[{"code":"69501","type":"CPT"}],"standard_charges":[{"minimum":750.64,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"MASTOIDECTOMY","code_information":[{"code":"69502","type":"CPT"}],"standard_charges":[{"minimum":996.68,"maximum":6494.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE MASTOID STRUCTURES","code_information":[{"code":"69505","type":"CPT"}],"standard_charges":[{"minimum":1293.14,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE MASTOID SURGERY","code_information":[{"code":"69511","type":"CPT"}],"standard_charges":[{"minimum":1323.54,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1323.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1323.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1323.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE MASTOID SURGERY","code_information":[{"code":"69530","type":"CPT"}],"standard_charges":[{"minimum":1761.62,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1761.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1761.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1761.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE PART OF TEMPORAL BONE","code_information":[{"code":"69535","type":"CPT"}],"standard_charges":[{"minimum":2797.28,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2797.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2797.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2797.28,"methodology":"fee schedule"}]}]},{"description":"REMOVE EAR LESION","code_information":[{"code":"69540","type":"CPT"}],"standard_charges":[{"minimum":138.04,"maximum":3093,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REMOVE EAR LESION","code_information":[{"code":"69550","type":"CPT"}],"standard_charges":[{"minimum":1119.34,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1119.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1119.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1119.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE EAR LESION","code_information":[{"code":"69552","type":"CPT"}],"standard_charges":[{"minimum":1668.28,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1668.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE EAR LESION","code_information":[{"code":"69554","type":"CPT"}],"standard_charges":[{"minimum":2659.6,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2659.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2659.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2659.6,"methodology":"fee schedule"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69601","type":"CPT"}],"standard_charges":[{"minimum":1073.92,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69602","type":"CPT"}],"standard_charges":[{"minimum":1149.02,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69603","type":"CPT"}],"standard_charges":[{"minimum":1351.79,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69604","type":"CPT"}],"standard_charges":[{"minimum":1173.7,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EARDRUM","code_information":[{"code":"69610","type":"CPT"}],"standard_charges":[{"minimum":303.62,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"REPAIR OF EARDRUM","code_information":[{"code":"69620","type":"CPT"}],"standard_charges":[{"minimum":523.55,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2326,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR EARDRUM STRUCTURES","code_information":[{"code":"69631","type":"CPT"}],"standard_charges":[{"minimum":940.18,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REBUILD EARDRUM STRUCTURES","code_information":[{"code":"69632","type":"CPT"}],"standard_charges":[{"minimum":1140.44,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REBUILD EARDRUM STRUCTURES","code_information":[{"code":"69633","type":"CPT"}],"standard_charges":[{"minimum":1110.76,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR EARDRUM STRUCTURES","code_information":[{"code":"69635","type":"CPT"}],"standard_charges":[{"minimum":1346.43,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REBUILD EARDRUM STRUCTURES","code_information":[{"code":"69636","type":"CPT"}],"standard_charges":[{"minimum":1481.96,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1481.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1481.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1481.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REBUILD EARDRUM STRUCTURES","code_information":[{"code":"69637","type":"CPT"}],"standard_charges":[{"minimum":1475.89,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1475.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69641","type":"CPT"}],"standard_charges":[{"minimum":1099.31,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69642","type":"CPT"}],"standard_charges":[{"minimum":1411.16,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69643","type":"CPT"}],"standard_charges":[{"minimum":1289.21,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1289.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69644","type":"CPT"}],"standard_charges":[{"minimum":1584.24,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1584.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1584.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1584.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69645","type":"CPT"}],"standard_charges":[{"minimum":1554.2,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1554.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1554.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1554.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69646","type":"CPT"}],"standard_charges":[{"minimum":1653.26,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RELEASE MIDDLE EAR BONE","code_information":[{"code":"69650","type":"CPT"}],"standard_charges":[{"minimum":848.63,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR BONE","code_information":[{"code":"69660","type":"CPT"}],"standard_charges":[{"minimum":975.22,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":975.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR BONE","code_information":[{"code":"69661","type":"CPT"}],"standard_charges":[{"minimum":1270.26,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REVISE MIDDLE EAR BONE","code_information":[{"code":"69662","type":"CPT"}],"standard_charges":[{"minimum":1219.83,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1219.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1219.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1219.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR MIDDLE EAR STRUCTURES","code_information":[{"code":"69666","type":"CPT"}],"standard_charges":[{"minimum":853.99,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":853.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":853.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":853.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REPAIR MIDDLE EAR STRUCTURES","code_information":[{"code":"69667","type":"CPT"}],"standard_charges":[{"minimum":856.49,"maximum":4005,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2897.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"REMOVE MASTOID AIR CELLS","code_information":[{"code":"69670","type":"CPT"}],"standard_charges":[{"minimum":995.96,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE MIDDLE EAR NERVE","code_information":[{"code":"69676","type":"CPT"}],"standard_charges":[{"minimum":881.17,"maximum":3592,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3533,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2788,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3592,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"CLOSE MASTOID FISTULA","code_information":[{"code":"69700","type":"CPT"}],"standard_charges":[{"minimum":703.79,"maximum":3239,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"NPS SURG DILAT EUST TUBE UNI","code_information":[{"code":"69705","type":"CPT"}],"standard_charges":[{"minimum":181.67,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"NPS SURG DILAT EUST TUBE BI","code_information":[{"code":"69706","type":"CPT"}],"standard_charges":[{"minimum":253.91,"maximum":6694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"IMPLANT/REPLACE HEARING AID","code_information":[{"code":"69710","type":"CPT"}],"standard_charges":[{"minimum":2346.1,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3127.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2346.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2595,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_percentage":14,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE/REPAIR HEARING AID","code_information":[{"code":"69711","type":"CPT"}],"standard_charges":[{"minimum":885.46,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1530.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2053,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"IMPLANT TEMPLE BONE W/STIMUL","code_information":[{"code":"69714","type":"CPT"}],"standard_charges":[{"minimum":522.12,"maximum":14125.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4345,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3431,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4419,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13850.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14125.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13987.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14056.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13713.71,"methodology":"fee schedule"}]}]},{"description":"TEMPLE BONE IMPLANT REVISION","code_information":[{"code":"69717","type":"CPT"}],"standard_charges":[{"minimum":591.5,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7613.93,"methodology":"fee schedule"}]}]},{"description":"RELEASE FACIAL NERVE","code_information":[{"code":"69720","type":"CPT"}],"standard_charges":[{"minimum":1240.93,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RELEASE FACIAL NERVE","code_information":[{"code":"69725","type":"CPT"}],"standard_charges":[{"minimum":1965.46,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR FACIAL NERVE","code_information":[{"code":"69740","type":"CPT"}],"standard_charges":[{"minimum":1222.69,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1222.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1222.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1222.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REPAIR FACIAL NERVE","code_information":[{"code":"69745","type":"CPT"}],"standard_charges":[{"minimum":1303.16,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1303.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1303.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1303.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"MIDDLE EAR SURGERY PROCEDURE","code_information":[{"code":"69799","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EAR","code_information":[{"code":"69801","type":"CPT"}],"standard_charges":[{"minimum":130.53,"maximum":4632,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4632,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4392.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3295.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3426,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3047,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2405,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3093,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1594.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1626.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1610.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1618.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1578.78,"methodology":"fee schedule"}]}]},{"description":"EXPLORE INNER EAR","code_information":[{"code":"69805","type":"CPT"}],"standard_charges":[{"minimum":1084.65,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"EXPLORE INNER EAR","code_information":[{"code":"69806","type":"CPT"}],"standard_charges":[{"minimum":971.65,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE INNER EAR","code_information":[{"code":"69905","type":"CPT"}],"standard_charges":[{"minimum":969.5,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE INNER EAR  MASTOID","code_information":[{"code":"69910","type":"CPT"}],"standard_charges":[{"minimum":1044.6,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EAR NERVE","code_information":[{"code":"69915","type":"CPT"}],"standard_charges":[{"minimum":1581.02,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3491.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3560.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3525.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3542.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3456.53,"methodology":"fee schedule"}]}]},{"description":"IMPLANT COCHLEAR DEVICE","code_information":[{"code":"69930","type":"CPT"}],"standard_charges":[{"minimum":1279.2,"maximum":34918.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6679,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6786,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33901.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34240.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34918.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34579.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33901.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33901.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33901.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34748.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33901.41,"methodology":"fee schedule"}]}]},{"description":"INNER EAR SURGERY PROCEDURE","code_information":[{"code":"69949","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":2732.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2732.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2049.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"INCISE INNER EAR NERVE","code_information":[{"code":"69950","type":"CPT"}],"standard_charges":[{"minimum":1834.22,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4044,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3193,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4110,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1834.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1834.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1834.22,"methodology":"fee schedule"}]}]},{"description":"RELEASE FACIAL NERVE","code_information":[{"code":"69955","type":"CPT"}],"standard_charges":[{"minimum":2067.03,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2067.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2067.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2067.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"RELEASE INNER EAR CANAL","code_information":[{"code":"69960","type":"CPT"}],"standard_charges":[{"minimum":1980.13,"maximum":6612,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1980.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1980.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1980.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"REMOVE INNER EAR LESION","code_information":[{"code":"69970","type":"CPT"}],"standard_charges":[{"minimum":2234.39,"maximum":8204.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8204.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6154.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":6477,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2234.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6368.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6494.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6431.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6462.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6305.03,"methodology":"fee schedule"}]}]},{"description":"TEMPORAL BONE SURGERY","code_information":[{"code":"69979","type":"CPT"}],"standard_charges":[{"minimum":157.25,"maximum":3133.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3133.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2350.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2350.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":247.5,"methodology":"fee schedule"}]}]},{"description":"MICROSURGERY ADD-ON","code_information":[{"code":"69990","type":"CPT"}],"standard_charges":[{"minimum":224.23,"maximum":2202,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1887,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1488,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1919,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.23,"methodology":"fee schedule"}]}]},{"description":"XR EYE FOREIGN BODY BIL","code_information":[{"code":"70030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":236.38,"maximum":364.39,"gross_charge":446,"discounted_cash":102.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.39,"methodology":"fee schedule"}]}]},{"description":"XR EYE FOREIGN BODY BIL","code_information":[{"code":"70030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.33,"maximum":364.39,"gross_charge":446,"discounted_cash":102.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR MANDIBLE <4 VIEWS","code_information":[{"code":"70100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":418.7,"maximum":645.43,"gross_charge":790,"discounted_cash":180.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":418.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":645.43,"methodology":"fee schedule"}]}]},{"description":"XR MANDIBLE <4 VIEWS","code_information":[{"code":"70100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":40.77,"maximum":645.43,"gross_charge":790,"discounted_cash":180.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":288.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":418.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":645.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR MANDIBLE 4+ VIEWS","code_information":[{"code":"70110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":481.24,"maximum":741.84,"gross_charge":908,"discounted_cash":207.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":481.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.84,"methodology":"fee schedule"}]}]},{"description":"XR MANDIBLE 4+ VIEWS","code_information":[{"code":"70110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":45.77,"maximum":741.84,"gross_charge":908,"discounted_cash":207.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":311.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":481.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR FACIAL BONES <3 VIEWS","code_information":[{"code":"70140","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":254.93,"maximum":392.98,"gross_charge":481,"discounted_cash":110.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.98,"methodology":"fee schedule"}]}]},{"description":"XR FACIAL BONES <3 VIEWS","code_information":[{"code":"70140","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.62,"maximum":392.98,"gross_charge":481,"discounted_cash":110.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FACIAL BONES 3+ VIEWS","code_information":[{"code":"70150","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":397.5,"maximum":612.75,"gross_charge":750,"discounted_cash":171.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":397.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":612.75,"methodology":"fee schedule"}]}]},{"description":"XR FACIAL BONES 3+ VIEWS","code_information":[{"code":"70150","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":49.71,"maximum":612.75,"gross_charge":750,"discounted_cash":171.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":340.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":397.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":612.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR NASAL BONES 3+ VIEWS","code_information":[{"code":"70160","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":215.71,"maximum":332.52,"gross_charge":407,"discounted_cash":93.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":215.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":332.52,"methodology":"fee schedule"}]}]},{"description":"XR NASAL BONES 3+ VIEWS","code_information":[{"code":"70160","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39.34,"maximum":332.52,"gross_charge":407,"discounted_cash":93.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":288.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":215.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":332.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ORBITS 4+ VIEWS","code_information":[{"code":"70200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":401.21,"maximum":618.47,"gross_charge":757,"discounted_cash":173.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":401.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":618.47,"methodology":"fee schedule"}]}]},{"description":"XR ORBITS 4+ VIEWS","code_information":[{"code":"70200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":50.42,"maximum":618.47,"gross_charge":757,"discounted_cash":173.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":340.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":401.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":618.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR SINUSES <3 VIEWS","code_information":[{"code":"70210","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":198.22,"maximum":305.56,"gross_charge":374,"discounted_cash":85.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":198.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":305.56,"methodology":"fee schedule"}]}]},{"description":"XR SINUSES <3 VIEWS","code_information":[{"code":"70210","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.97,"maximum":311.33,"gross_charge":374,"discounted_cash":85.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":198.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":305.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR SINUSES 3+ VIEWS","code_information":[{"code":"70220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":251.22,"maximum":387.26,"gross_charge":474,"discounted_cash":108.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":251.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":387.26,"methodology":"fee schedule"}]}]},{"description":"XR SINUSES 3+ VIEWS","code_information":[{"code":"70220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39.34,"maximum":387.26,"gross_charge":474,"discounted_cash":108.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":266.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":266.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":70.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":70.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":251.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":387.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR SKULL <4 VIEWS","code_information":[{"code":"70250","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":436.19,"maximum":672.4,"gross_charge":823,"discounted_cash":188.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":436.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":672.4,"methodology":"fee schedule"}]}]},{"description":"XR SKULL <4 VIEWS","code_information":[{"code":"70250","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":37.91,"maximum":672.4,"gross_charge":823,"discounted_cash":188.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":262.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":262.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":70.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":70.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":436.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":672.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR SKULL 4+ VIEWS","code_information":[{"code":"70260","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":454.21,"maximum":700.17,"gross_charge":857,"discounted_cash":196.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":454.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":700.17,"methodology":"fee schedule"}]}]},{"description":"XR SKULL 4+ VIEWS","code_information":[{"code":"70260","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":46.85,"maximum":700.17,"gross_charge":857,"discounted_cash":196.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":305.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":305.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":80.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":80.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":454.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":700.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"MR TMJ(S) UNI OR BIL","code_information":[{"code":"70336","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":941.28,"maximum":1451,"gross_charge":1776,"discounted_cash":406.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":941.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1451,"methodology":"fee schedule"}]}]},{"description":"MR TMJ(S) UNI OR BIL","code_information":[{"code":"70336","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":257.63,"maximum":1698,"gross_charge":1776,"discounted_cash":406.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":894.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":670.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":670.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":941.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1451,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"XR NECK SOFT TISSUE","code_information":[{"code":"70360","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":349.8,"maximum":539.22,"gross_charge":660,"discounted_cash":151.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":349.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":539.22,"methodology":"fee schedule"}]}]},{"description":"XR NECK SOFT TISSUE","code_information":[{"code":"70360","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.9,"maximum":539.22,"gross_charge":660,"discounted_cash":151.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":349.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":539.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"CT HEAD WO CON","code_information":[{"code":"70450","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":1928.14,"maximum":2972.25,"gross_charge":3638,"discounted_cash":833.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1928.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2972.25,"methodology":"fee schedule"}]}]},{"description":"CT HEAD WO CON","code_information":[{"code":"70450","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":2972.25,"gross_charge":3638,"discounted_cash":833.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":310.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":233.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":233.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1928.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2972.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT HEAD W CON","code_information":[{"code":"70460","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2583.75,"maximum":3982.88,"gross_charge":4875,"discounted_cash":1116.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2583.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3982.88,"methodology":"fee schedule"}]}]},{"description":"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"minimum":219099.3,"maximum":570087.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":519102,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":519102,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":446655.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":334998.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":334998.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":502246.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":414176.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":570087.35,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":219099.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":221290.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":225672.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":223481.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":219099.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":219099.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":219099.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":224576.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":219099.3,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT","code_information":[{"code":"0011","type":"APR-DRG"}],"standard_charges":[{"minimum":44527,"maximum":44527,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44527,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44527,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44527,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT","code_information":[{"code":"0012","type":"APR-DRG"}],"standard_charges":[{"minimum":44527,"maximum":44527,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44527,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44527,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44527,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT","code_information":[{"code":"0013","type":"APR-DRG"}],"standard_charges":[{"minimum":52769,"maximum":52769,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52769,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52769,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52769,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT","code_information":[{"code":"0014","type":"APR-DRG"}],"standard_charges":[{"minimum":111950,"maximum":111950,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111950,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111950,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111950,"methodology":"case rate"}]}]},{"description":"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"minimum":86488.85,"maximum":314501.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":263247,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":263247,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":314501.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":235880.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":235880.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":254698.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":210037.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":289102.63,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":86488.85,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":87353.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":89083.52,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":88218.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":86488.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":86488.85,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":86488.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":88651.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":86488.85,"methodology":"case rate"}]}]},{"description":"HEART AND/OR LUNG TRANSPLANT","code_information":[{"code":"0021","type":"APR-DRG"}],"standard_charges":[{"minimum":58849,"maximum":58849,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58849,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58849,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58849,"methodology":"case rate"}]}]},{"description":"HEART AND/OR LUNG TRANSPLANT","code_information":[{"code":"0022","type":"APR-DRG"}],"standard_charges":[{"minimum":76126,"maximum":76126,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76126,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76126,"methodology":"case rate"}]}]},{"description":"HEART AND/OR LUNG TRANSPLANT","code_information":[{"code":"0023","type":"APR-DRG"}],"standard_charges":[{"minimum":90803,"maximum":90803,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90803,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90803,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90803,"methodology":"case rate"}]}]},{"description":"HEART AND/OR LUNG TRANSPLANT","code_information":[{"code":"0024","type":"APR-DRG"}],"standard_charges":[{"minimum":172745,"maximum":172745,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":172745,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":172745,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":172745,"methodology":"case rate"}]}]},{"description":"RX MTAB ADVERSE TRGT SEQ ANLS","code_information":[{"code":"0029U","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":687.94,"maximum":1060.47,"gross_charge":1298,"discounted_cash":297.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":687.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1060.47,"methodology":"fee schedule"}]}]},{"description":"RX MTAB ADVERSE TRGT SEQ ANLS","code_information":[{"code":"0029U","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":445.36,"maximum":1060.47,"gross_charge":1298,"discounted_cash":297.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":731.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":549,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":549,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":687.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1060.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":445.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":445.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":749.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":764.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":757.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":760.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":742.27,"methodology":"fee schedule"}]}]},{"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":167004.27,"maximum":438460.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":356049,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":356049,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":407887.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":305921.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":305921.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":383285.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":284081.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":438460.56,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":167004.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168674.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":172014.4,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170344.36,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":167004.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":167004.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":167004.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":171179.38,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":167004.27,"methodology":"case rate"}]}]},{"description":"TRGT GENOMIC SEQ/DNA ANLS 324","code_information":[{"code":"0037U","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":8024.73,"maximum":12370.2,"gross_charge":15141,"discounted_cash":3467.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8024.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12370.2,"methodology":"fee schedule"}]}]},{"description":"TRGT GENOMIC SEQ/DNA ANLS 324","code_information":[{"code":"0037U","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":2100,"maximum":12370.2,"gross_charge":15141,"discounted_cash":3467.29,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10962.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8223.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8223.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8024.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12370.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2100,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2100,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2100,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3587.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3587.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3587.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3500,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3535,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3605,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3570,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3500,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3500,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3500,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3587.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3500,"methodology":"fee schedule"}]}]},{"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":110540.86,"maximum":267042.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216850,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":216850,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241013.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":180763.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":180763.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":233438.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":173018.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":267042.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":110540.86,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":111646.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":113857.09,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":112751.68,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":110540.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":110540.86,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":110540.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":113304.39,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":110540.86,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE","code_information":[{"code":"0041","type":"APR-DRG"}],"standard_charges":[{"minimum":41935,"maximum":41935,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41935,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41935,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41935,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE","code_information":[{"code":"0042","type":"APR-DRG"}],"standard_charges":[{"minimum":49783,"maximum":49783,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49783,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49783,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49783,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE","code_information":[{"code":"0043","type":"APR-DRG"}],"standard_charges":[{"minimum":71072,"maximum":71072,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71072,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71072,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71072,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE","code_information":[{"code":"0044","type":"APR-DRG"}],"standard_charges":[{"minimum":103939,"maximum":103939,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":103939,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":103939,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":103939,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"minimum":83625.31,"maximum":226245.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193724,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":193724,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":226245.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":169687.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":169687.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":187433.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154566.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":212751,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":83625.31,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":84461.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":86134.07,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":85297.82,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":83625.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":83625.31,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":83625.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":85715.95,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":83625.31,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE","code_information":[{"code":"0051","type":"APR-DRG"}],"standard_charges":[{"minimum":27708,"maximum":27708,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27708,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27708,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27708,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE","code_information":[{"code":"0052","type":"APR-DRG"}],"standard_charges":[{"minimum":37716,"maximum":37716,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37716,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37716,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37716,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE","code_information":[{"code":"0053","type":"APR-DRG"}],"standard_charges":[{"minimum":47950,"maximum":47950,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47950,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47950,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47950,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE","code_information":[{"code":"0054","type":"APR-DRG"}],"standard_charges":[{"minimum":68217,"maximum":68217,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68217,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68217,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68217,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT WITHOUT MCC","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"minimum":38772.26,"maximum":154699.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91518,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91518,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154699.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":116027.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":116027.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":88546.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":73020.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":100507.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38772.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":39159.99,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39935.43,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":39547.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38772.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38772.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38772.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39741.57,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38772.26,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"0061","type":"APR-DRG"}],"standard_charges":[{"minimum":49905,"maximum":49905,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49905,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49905,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49905,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"0062","type":"APR-DRG"}],"standard_charges":[{"minimum":49905,"maximum":49905,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49905,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49905,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49905,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"0063","type":"APR-DRG"}],"standard_charges":[{"minimum":55672,"maximum":55672,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55672,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55672,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55672,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"0064","type":"APR-DRG"}],"standard_charges":[{"minimum":92525,"maximum":92525,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92525,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92525,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92525,"methodology":"case rate"}]}]},{"description":"LUNG TRANSPLANT","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"minimum":102334.58,"maximum":222521.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202620,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202620,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218589.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":163945.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":163945.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":196041,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":161665.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":222521.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":102334.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":103357.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":105404.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":104381.28,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":102334.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":102334.58,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":102334.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":104892.95,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":102334.58,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"0071","type":"APR-DRG"}],"standard_charges":[{"minimum":38654,"maximum":38654,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38654,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38654,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38654,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"0072","type":"APR-DRG"}],"standard_charges":[{"minimum":56005,"maximum":56005,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56005,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56005,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56005,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"0073","type":"APR-DRG"}],"standard_charges":[{"minimum":67436,"maximum":67436,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67436,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67436,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67436,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"0074","type":"APR-DRG"}],"standard_charges":[{"minimum":131015,"maximum":131015,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":131015,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":131015,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":131015,"methodology":"case rate"}]}]},{"description":"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"minimum":43349.43,"maximum":182038.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105498,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105498,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182038.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":136531.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":136531.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":102072.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":84174.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":115860.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":43349.43,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43782.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44649.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":44216.42,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":43349.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":43349.43,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":43349.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44433.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":43349.43,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY","code_information":[{"code":"0081","type":"APR-DRG"}],"standard_charges":[{"minimum":26320,"maximum":26320,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26320,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26320,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26320,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY","code_information":[{"code":"0082","type":"APR-DRG"}],"standard_charges":[{"minimum":31589,"maximum":31589,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31589,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31589,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31589,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY","code_information":[{"code":"0083","type":"APR-DRG"}],"standard_charges":[{"minimum":37024,"maximum":37024,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37024,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37024,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37024,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY","code_information":[{"code":"0084","type":"APR-DRG"}],"standard_charges":[{"minimum":59102,"maximum":59102,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":59102,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":59102,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":59102,"methodology":"case rate"}]}]},{"description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)","code_information":[{"code":"0091","type":"APR-DRG"}],"standard_charges":[{"minimum":31367,"maximum":31367,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31367,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31367,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31367,"methodology":"case rate"}]}]},{"description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)","code_information":[{"code":"0092","type":"APR-DRG"}],"standard_charges":[{"minimum":31367,"maximum":31367,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31367,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31367,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31367,"methodology":"case rate"}]}]},{"description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)","code_information":[{"code":"0093","type":"APR-DRG"}],"standard_charges":[{"minimum":52395,"maximum":52395,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52395,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52395,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52395,"methodology":"case rate"}]}]},{"description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)","code_information":[{"code":"0094","type":"APR-DRG"}],"standard_charges":[{"minimum":118382,"maximum":118382,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118382,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118382,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"minimum":59593.78,"maximum":140302.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74691,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74691,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140302.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":105228.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":105228.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":72265.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":59593.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82026.94,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":62928.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63557.95,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":64816.52,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64187.24,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":62928.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":62928.66,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":62928.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64501.88,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":62928.66,"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":42999.9,"maximum":101990.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92869,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92869,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86396.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":64798.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":64798.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":89853.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74097.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":101990.59,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42999.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43429.9,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44289.9,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43859.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42999.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42999.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42999.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44074.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42999.9,"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":33007.29,"maximum":77857.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70894,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70894,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67631.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50724.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50724.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":68592.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":56564.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":77857.62,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33007.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":33337.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33997.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33667.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33007.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33007.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33007.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33832.48,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33007.29,"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":21765.8,"maximum":55735.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45559,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45559,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55735.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41802.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41802.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":44079.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36350.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50033.93,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21765.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21983.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22418.78,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22201.12,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21765.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21765.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21765.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22309.95,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21765.8,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"minimum":102589.77,"maximum":263131.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":239598,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":239598,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223739.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":167808.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":167808.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":231818.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":191168.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":263131.52,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":102589.77,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":103615.67,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":105667.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":104641.57,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":102589.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":102589.77,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":102589.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":105154.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":102589.77,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"minimum":47949.03,"maximum":160995.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129338,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129338,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160995.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":120748.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":120748.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":125138.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":103195.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142041.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":48428.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":49387.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":48908.02,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":49147.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"minimum":47949.03,"maximum":110236.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83544,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83544,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110236.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":82678.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":82678.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80831.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":66657.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":91749.86,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":48428.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":49387.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":48908.02,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":49147.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":47949.03,"methodology":"case rate"}]}]},{"description":"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"minimum":127103.35,"maximum":301694.33,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169467.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":127103.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":127103.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":292907.11,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":295836.19,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":301694.33,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":298765.26,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":292907.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":292907.11,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":292907.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":300229.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":292907.11,"methodology":"case rate"}]}]},{"description":"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"minimum":62575.26,"maximum":215876.41,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":215876.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":161910.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":161910.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":62575.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63201.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":64452.52,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":63826.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":62575.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":62575.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":62575.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64139.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":62575.26,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"minimum":63609.94,"maximum":250322.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207433,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207433,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217302.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162979.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162979.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":218822.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":162185.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":250322.19,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63609.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":64246.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65518.24,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64882.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63609.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63609.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63609.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":65200.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63609.94,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY FOR TRAUMA","code_information":[{"code":"0201","type":"APR-DRG"}],"standard_charges":[{"minimum":14215,"maximum":14215,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14215,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14215,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14215,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY FOR TRAUMA","code_information":[{"code":"0202","type":"APR-DRG"}],"standard_charges":[{"minimum":17830,"maximum":17830,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17830,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17830,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17830,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY FOR TRAUMA","code_information":[{"code":"0203","type":"APR-DRG"}],"standard_charges":[{"minimum":23058,"maximum":23058,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23058,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23058,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23058,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY FOR TRAUMA","code_information":[{"code":"0204","type":"APR-DRG"}],"standard_charges":[{"minimum":38140,"maximum":38140,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38140,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38140,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38140,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"minimum":44016.02,"maximum":191395.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157025,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157025,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188956.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":141720.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":141720.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":167310.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":124006.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":191395.5,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":44456.19,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":45336.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":44896.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":45116.43,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY EXCEPT TRAUMA","code_information":[{"code":"0211","type":"APR-DRG"}],"standard_charges":[{"minimum":12843,"maximum":12843,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12843,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12843,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12843,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY EXCEPT TRAUMA","code_information":[{"code":"0212","type":"APR-DRG"}],"standard_charges":[{"minimum":16801,"maximum":16801,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16801,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16801,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16801,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY EXCEPT TRAUMA","code_information":[{"code":"0213","type":"APR-DRG"}],"standard_charges":[{"minimum":26059,"maximum":26059,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26059,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26059,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26059,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY EXCEPT TRAUMA","code_information":[{"code":"0214","type":"APR-DRG"}],"standard_charges":[{"minimum":42642,"maximum":42642,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42642,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42642,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42642,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"minimum":28573.95,"maximum":158129.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101235,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101235,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":158129.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":118599.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":118599.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":99730.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":73917.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":114087.32,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28573.95,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28859.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29431.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29145.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28573.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28573.95,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28573.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29288.3,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28573.95,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES","code_information":[{"code":"0221","type":"APR-DRG"}],"standard_charges":[{"minimum":8226,"maximum":8226,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8226,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8226,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8226,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES","code_information":[{"code":"0222","type":"APR-DRG"}],"standard_charges":[{"minimum":10531,"maximum":10531,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10531,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10531,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10531,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES","code_information":[{"code":"0223","type":"APR-DRG"}],"standard_charges":[{"minimum":17268,"maximum":17268,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17268,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17268,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17268,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES","code_information":[{"code":"0224","type":"APR-DRG"}],"standard_charges":[{"minimum":38104,"maximum":38104,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38104,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38104,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38104,"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":45390.95,"maximum":129940.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105517,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105517,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123478.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":92610.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":92610.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":113588.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":84189.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":129940.37,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":45390.95,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":45844.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":46752.68,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":46298.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":45390.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":45390.95,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":45390.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":46525.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":45390.95,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES","code_information":[{"code":"0231","type":"APR-DRG"}],"standard_charges":[{"minimum":10034,"maximum":10034,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10034,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10034,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10034,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES","code_information":[{"code":"0232","type":"APR-DRG"}],"standard_charges":[{"minimum":13767,"maximum":13767,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13767,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13767,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES","code_information":[{"code":"0233","type":"APR-DRG"}],"standard_charges":[{"minimum":24506,"maximum":24506,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24506,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24506,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24506,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES","code_information":[{"code":"0234","type":"APR-DRG"}],"standard_charges":[{"minimum":38597,"maximum":38597,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38597,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38597,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38597,"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":30671.92,"maximum":102324.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75449,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75449,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102324.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76744.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76744.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":81221.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":60199.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":92913.69,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":30671.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":30978.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31592.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31285.36,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":30671.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30671.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":30671.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31438.72,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":30671.92,"methodology":"case rate"}]}]},{"description":"OPEN EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0241","type":"APR-DRG"}],"standard_charges":[{"minimum":5831,"maximum":5831,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5831,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5831,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5831,"methodology":"case rate"}]}]},{"description":"CP RESP VIRUS RNA 4 TARGETS","code_information":[{"code":"0241U","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":327.54,"maximum":504.91,"gross_charge":618,"discounted_cash":141.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":327.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":504.91,"methodology":"fee schedule"}]}]},{"description":"CP RESP VIRUS RNA 4 TARGETS","code_information":[{"code":"0241U","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":85.58,"maximum":504.91,"gross_charge":618,"discounted_cash":141.53,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":327.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":504.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"}]}]},{"description":"OPEN EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0242","type":"APR-DRG"}],"standard_charges":[{"minimum":7978,"maximum":7978,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7978,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7978,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7978,"methodology":"case rate"}]}]},{"description":"OPEN EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0243","type":"APR-DRG"}],"standard_charges":[{"minimum":14664,"maximum":14664,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14664,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14664,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14664,"methodology":"case rate"}]}]},{"description":"OPEN EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0244","type":"APR-DRG"}],"standard_charges":[{"minimum":26793,"maximum":26793,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26793,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26793,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26793,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"minimum":35857.68,"maximum":136841.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114476,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114476,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136841.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":102632.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":102632.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":88865.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":65864.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":101657.96,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35857.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":36216.26,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36933.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":36574.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35857.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35857.68,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35857.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36754.13,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35857.68,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"minimum":24925.51,"maximum":102016.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72621,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72621,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102016.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76513.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76513.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":61592.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":45650.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70458.49,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24925.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25174.77,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25673.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25424.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24925.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24925.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24925.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25548.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24925.51,"methodology":"case rate"}]}]},{"description":"OTHER NERVOUS SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"0261","type":"APR-DRG"}],"standard_charges":[{"minimum":8541,"maximum":8541,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8541,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8541,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8541,"methodology":"case rate"}]}]},{"description":"OTHER NERVOUS SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"0262","type":"APR-DRG"}],"standard_charges":[{"minimum":10772,"maximum":10772,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10772,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10772,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10772,"methodology":"case rate"}]}]},{"description":"OTHER NERVOUS SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"0263","type":"APR-DRG"}],"standard_charges":[{"minimum":16177,"maximum":16177,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16177,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16177,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16177,"methodology":"case rate"}]}]},{"description":"OTHER NERVOUS SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"0264","type":"APR-DRG"}],"standard_charges":[{"minimum":32576,"maximum":32576,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32576,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32576,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32576,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"minimum":20356.84,"maximum":75131.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52003,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52003,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75131.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":56349.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":56349.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":48466.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":35921.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":55442.86,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20356.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20560.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20967.55,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20763.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20356.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20356.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20356.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20865.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20356.84,"methodology":"case rate"}]}]},{"description":"OTHER OPEN CRANIOTOMY","code_information":[{"code":"0271","type":"APR-DRG"}],"standard_charges":[{"minimum":10709,"maximum":10709,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10709,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10709,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10709,"methodology":"case rate"}]}]},{"description":"OTHER OPEN CRANIOTOMY","code_information":[{"code":"0272","type":"APR-DRG"}],"standard_charges":[{"minimum":13247,"maximum":13247,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13247,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13247,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13247,"methodology":"case rate"}]}]},{"description":"OTHER OPEN CRANIOTOMY","code_information":[{"code":"0273","type":"APR-DRG"}],"standard_charges":[{"minimum":20763,"maximum":20763,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20763,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20763,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20763,"methodology":"case rate"}]}]},{"description":"OTHER OPEN CRANIOTOMY","code_information":[{"code":"0274","type":"APR-DRG"}],"standard_charges":[{"minimum":38984,"maximum":38984,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38984,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38984,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38984,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITH MCC","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"minimum":48286.19,"maximum":137769,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137769,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137769,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116628.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":87473.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":87473.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":113049.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":83788.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":129322.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":48286.19,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":48769.06,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":49734.78,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":49251.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":48286.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":48286.19,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":48286.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":49493.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":48286.19,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"minimum":27230.72,"maximum":78111.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69057,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69057,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78111.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58584.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58584.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":64851.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":48066.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":74187.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27230.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27503.03,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28047.65,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27775.34,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27230.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27230.72,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27230.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27911.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27230.72,"methodology":"case rate"}]}]},{"description":"OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES","code_information":[{"code":"0291","type":"APR-DRG"}],"standard_charges":[{"minimum":12581,"maximum":12581,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12581,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12581,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12581,"methodology":"case rate"}]}]},{"description":"OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES","code_information":[{"code":"0292","type":"APR-DRG"}],"standard_charges":[{"minimum":12581,"maximum":12581,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12581,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12581,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12581,"methodology":"case rate"}]}]},{"description":"OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES","code_information":[{"code":"0293","type":"APR-DRG"}],"standard_charges":[{"minimum":17050,"maximum":17050,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17050,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17050,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17050,"methodology":"case rate"}]}]},{"description":"OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES","code_information":[{"code":"0294","type":"APR-DRG"}],"standard_charges":[{"minimum":30621,"maximum":30621,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30621,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30621,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30621,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"minimum":18482.36,"maximum":52560.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41287,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41287,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48526.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36395.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36395.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45946.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34054.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52560.48,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18482.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18667.19,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19036.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18852.01,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18482.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18482.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18482.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18944.42,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18482.36,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0301","type":"APR-DRG"}],"standard_charges":[{"minimum":12432,"maximum":12432,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12432,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12432,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12432,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0302","type":"APR-DRG"}],"standard_charges":[{"minimum":17775,"maximum":17775,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17775,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17775,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17775,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0303","type":"APR-DRG"}],"standard_charges":[{"minimum":24885,"maximum":24885,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24885,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24885,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24885,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0304","type":"APR-DRG"}],"standard_charges":[{"minimum":35084,"maximum":35084,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35084,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35084,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35084,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH MCC","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"minimum":33679.29,"maximum":108621,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108621,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108621,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98596.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":73949.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":73949.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":88461.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":65565,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":101195.3,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33679.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34016.09,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34689.67,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34352.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33679.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33679.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33679.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34521.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33679.29,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH CC","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"minimum":17787.94,"maximum":53569.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47548,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47548,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53569.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40177.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40177.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":44328.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32855.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50709.84,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17787.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17965.82,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18321.58,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18143.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17787.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17787.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17787.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18232.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17787.94,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"minimum":13611.33,"maximum":39346.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34361,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34361,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38801.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29101.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29101.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34395.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25493.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39346.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13611.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13747.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14019.67,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13883.56,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13611.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13611.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13611.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13951.62,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13611.33,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITH MCC","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"minimum":31344.69,"maximum":77438.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70513,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70513,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75155.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":56367.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":56367.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":68223.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":56260.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":77438.83,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31344.69,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31658.14,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32285.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31971.59,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31344.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31344.69,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31344.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32128.31,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31344.69,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITH CC","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"minimum":18864.37,"maximum":56123.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43246,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43246,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56123.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42093.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42093.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":41842.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34505.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47494.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18864.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19053.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19430.31,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19241.66,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18864.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18864.37,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18864.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19335.98,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18864.37,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"minimum":15448.7,"maximum":50160.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32892,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32892,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50160.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37620.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37620.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31824.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26243.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36123.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15448.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15603.19,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15912.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15757.68,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15448.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15448.7,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15448.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15834.92,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15448.7,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITH MCC","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"minimum":26953.88,"maximum":75244,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75244,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75244,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55102.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41327.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41327.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":65586.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":48610.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":75027.25,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26953.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27223.42,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27762.5,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27492.96,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26953.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26953.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26953.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27627.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26953.88,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITH CC","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"minimum":13733.51,"maximum":38752.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38552,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38552,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35762.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26822.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26822.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33875.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25107.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38752.4,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13733.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13870.85,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14145.52,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14008.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13733.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13733.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13733.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14076.85,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13733.51,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"minimum":10075.02,"maximum":26563.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21251,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21251,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26563.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19922.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19922.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22877.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16955.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26170.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10075.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10175.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10377.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10276.53,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10075.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10075.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10075.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10326.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10075.02,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"minimum":30443.02,"maximum":98386,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98386,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98386,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64810.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48608.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48608.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":79682.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":59058.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":91153.27,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":30443.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":30747.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31356.32,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31051.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":30443.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30443.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":30443.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31204.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":30443.02,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES","code_information":[{"code":"0401","type":"APR-DRG"}],"standard_charges":[{"minimum":6530,"maximum":6530,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6530,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6530,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6530,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES","code_information":[{"code":"0402","type":"APR-DRG"}],"standard_charges":[{"minimum":8842,"maximum":8842,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8842,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8842,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8842,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES","code_information":[{"code":"0403","type":"APR-DRG"}],"standard_charges":[{"minimum":13280,"maximum":13280,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13280,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13280,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13280,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES","code_information":[{"code":"0404","type":"APR-DRG"}],"standard_charges":[{"minimum":22211,"maximum":22211,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22211,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22211,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22211,"methodology":"case rate"}]}]},{"description":"INSJ/RPLC CARDIAC MODULJ SYS","code_information":[{"code":"0408T","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERIPHERAL CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"minimum":18736,"maximum":54859.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53120,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53120,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46983.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35237.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35237.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":47956.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":35544.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54859.9,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18736,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18923.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19298.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19110.72,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18736,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18736,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18736,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19204.4,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18736,"methodology":"case rate"}]}]},{"description":"INSJ/RPLC CAR MODULJ ATR ELT","code_information":[{"code":"0410T","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NERVOUS SYSTEM MALIGNANCY","code_information":[{"code":"0411","type":"APR-DRG"}],"standard_charges":[{"minimum":4985,"maximum":4985,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4985,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4985,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4985,"methodology":"case rate"}]}]},{"description":"INSJ/RPLC CAR MODULJ VNT ELT","code_information":[{"code":"0411T","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NERVOUS SYSTEM MALIGNANCY","code_information":[{"code":"0412","type":"APR-DRG"}],"standard_charges":[{"minimum":5573,"maximum":5573,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5573,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5573,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5573,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM MALIGNANCY","code_information":[{"code":"0413","type":"APR-DRG"}],"standard_charges":[{"minimum":7443,"maximum":7443,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7443,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7443,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7443,"methodology":"case rate"}]}]},{"description":"RMVL CAR MODULJ TRANVNS ELT","code_information":[{"code":"0413T","type":"CPT"}],"standard_charges":[{"minimum":6694,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6694,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NERVOUS SYSTEM MALIGNANCY","code_information":[{"code":"0414","type":"APR-DRG"}],"standard_charges":[{"minimum":11662,"maximum":11662,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11662,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11662,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11662,"methodology":"case rate"}]}]},{"description":"REPOS CAR MODULJ TRANVNS ELT","code_information":[{"code":"0415T","type":"CPT"}],"standard_charges":[{"minimum":3146,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3146,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERIPHERAL CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"minimum":14864.85,"maximum":42756.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42550,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42550,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37254.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27941.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27941.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37376.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27702.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42756.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14864.85,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15013.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15310.8,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15162.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14864.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14864.85,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14864.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15236.48,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14864.85,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS","code_information":[{"code":"0421","type":"APR-DRG"}],"standard_charges":[{"minimum":4288,"maximum":4288,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4288,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4288,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4288,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS","code_information":[{"code":"0422","type":"APR-DRG"}],"standard_charges":[{"minimum":5145,"maximum":5145,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5145,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5145,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5145,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS","code_information":[{"code":"0423","type":"APR-DRG"}],"standard_charges":[{"minimum":7799,"maximum":7799,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7799,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7799,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7799,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS","code_information":[{"code":"0424","type":"APR-DRG"}],"standard_charges":[{"minimum":16424,"maximum":16424,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16424,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16424,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16424,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES","code_information":[{"code":"0431","type":"APR-DRG"}],"standard_charges":[{"minimum":5447,"maximum":5447,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5447,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5447,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES","code_information":[{"code":"0432","type":"APR-DRG"}],"standard_charges":[{"minimum":7482,"maximum":7482,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7482,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7482,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7482,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES","code_information":[{"code":"0433","type":"APR-DRG"}],"standard_charges":[{"minimum":11583,"maximum":11583,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11583,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11583,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11583,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES","code_information":[{"code":"0434","type":"APR-DRG"}],"standard_charges":[{"minimum":22361,"maximum":22361,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22361,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22361,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22361,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE","code_information":[{"code":"0441","type":"APR-DRG"}],"standard_charges":[{"minimum":5245,"maximum":5245,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5245,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5245,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5245,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE","code_information":[{"code":"0442","type":"APR-DRG"}],"standard_charges":[{"minimum":6928,"maximum":6928,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6928,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6928,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6928,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE","code_information":[{"code":"0443","type":"APR-DRG"}],"standard_charges":[{"minimum":9819,"maximum":9819,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9819,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9819,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9819,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE","code_information":[{"code":"0444","type":"APR-DRG"}],"standard_charges":[{"minimum":13595,"maximum":13595,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13595,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13595,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13595,"methodology":"case rate"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION","code_information":[{"code":"0451","type":"APR-DRG"}],"standard_charges":[{"minimum":4659,"maximum":4659,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4659,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4659,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4659,"methodology":"case rate"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION","code_information":[{"code":"0452","type":"APR-DRG"}],"standard_charges":[{"minimum":5856,"maximum":5856,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION","code_information":[{"code":"0453","type":"APR-DRG"}],"standard_charges":[{"minimum":8461,"maximum":8461,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8461,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8461,"methodology":"case rate"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION","code_information":[{"code":"0454","type":"APR-DRG"}],"standard_charges":[{"minimum":15248,"maximum":15248,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15248,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15248,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15248,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION","code_information":[{"code":"0461","type":"APR-DRG"}],"standard_charges":[{"minimum":4634,"maximum":4634,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4634,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4634,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4634,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION","code_information":[{"code":"0462","type":"APR-DRG"}],"standard_charges":[{"minimum":5398,"maximum":5398,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5398,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5398,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5398,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION","code_information":[{"code":"0463","type":"APR-DRG"}],"standard_charges":[{"minimum":7119,"maximum":7119,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7119,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7119,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7119,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION","code_information":[{"code":"0464","type":"APR-DRG"}],"standard_charges":[{"minimum":12779,"maximum":12779,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12779,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12779,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12779,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA","code_information":[{"code":"0471","type":"APR-DRG"}],"standard_charges":[{"minimum":4089,"maximum":4089,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4089,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4089,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4089,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA","code_information":[{"code":"0472","type":"APR-DRG"}],"standard_charges":[{"minimum":4530,"maximum":4530,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4530,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4530,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4530,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA","code_information":[{"code":"0473","type":"APR-DRG"}],"standard_charges":[{"minimum":5856,"maximum":5856,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA","code_information":[{"code":"0474","type":"APR-DRG"}],"standard_charges":[{"minimum":10823,"maximum":10823,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10823,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10823,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10823,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL AND AUTONOMIC NERVE DISORDERS","code_information":[{"code":"0481","type":"APR-DRG"}],"standard_charges":[{"minimum":4114,"maximum":4114,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4114,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4114,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4114,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL AND AUTONOMIC NERVE DISORDERS","code_information":[{"code":"0482","type":"APR-DRG"}],"standard_charges":[{"minimum":4702,"maximum":4702,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4702,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4702,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4702,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL AND AUTONOMIC NERVE DISORDERS","code_information":[{"code":"0483","type":"APR-DRG"}],"standard_charges":[{"minimum":6758,"maximum":6758,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL AND AUTONOMIC NERVE DISORDERS","code_information":[{"code":"0484","type":"APR-DRG"}],"standard_charges":[{"minimum":13912,"maximum":13912,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13912,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13912,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13912,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM","code_information":[{"code":"0491","type":"APR-DRG"}],"standard_charges":[{"minimum":5562,"maximum":5562,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5562,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5562,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5562,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM","code_information":[{"code":"0492","type":"APR-DRG"}],"standard_charges":[{"minimum":12079,"maximum":12079,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12079,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12079,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12079,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM","code_information":[{"code":"0493","type":"APR-DRG"}],"standard_charges":[{"minimum":15971,"maximum":15971,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15971,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15971,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15971,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM","code_information":[{"code":"0494","type":"APR-DRG"}],"standard_charges":[{"minimum":25791,"maximum":25791,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25791,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25791,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25791,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS","code_information":[{"code":"0501","type":"APR-DRG"}],"standard_charges":[{"minimum":4206,"maximum":4206,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4206,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4206,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4206,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS","code_information":[{"code":"0502","type":"APR-DRG"}],"standard_charges":[{"minimum":7623,"maximum":7623,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7623,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7623,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7623,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS","code_information":[{"code":"0503","type":"APR-DRG"}],"standard_charges":[{"minimum":13331,"maximum":13331,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13331,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13331,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13331,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS","code_information":[{"code":"0504","type":"APR-DRG"}],"standard_charges":[{"minimum":27028,"maximum":27028,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27028,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27028,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27028,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS","code_information":[{"code":"0511","type":"APR-DRG"}],"standard_charges":[{"minimum":2998,"maximum":2998,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2998,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2998,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2998,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS","code_information":[{"code":"0512","type":"APR-DRG"}],"standard_charges":[{"minimum":4519,"maximum":4519,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4519,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4519,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4519,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS","code_information":[{"code":"0513","type":"APR-DRG"}],"standard_charges":[{"minimum":8511,"maximum":8511,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8511,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8511,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8511,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS","code_information":[{"code":"0514","type":"APR-DRG"}],"standard_charges":[{"minimum":14764,"maximum":14764,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14764,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14764,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14764,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES WITH CC/MCC","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"minimum":16836,"maximum":37681.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30598,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30598,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34724.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26043.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26043.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32939.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24413.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37681.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16836,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17004.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17341.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17172.72,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16836,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16836,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16836,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17256.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16836,"methodology":"case rate"}]}]},{"description":"ALTERATION IN CONSCIOUSNESS","code_information":[{"code":"0521","type":"APR-DRG"}],"standard_charges":[{"minimum":3828,"maximum":3828,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3828,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3828,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3828,"methodology":"case rate"}]}]},{"description":"ALTERATION IN CONSCIOUSNESS","code_information":[{"code":"0522","type":"APR-DRG"}],"standard_charges":[{"minimum":4301,"maximum":4301,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4301,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4301,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4301,"methodology":"case rate"}]}]},{"description":"ALTERATION IN CONSCIOUSNESS","code_information":[{"code":"0523","type":"APR-DRG"}],"standard_charges":[{"minimum":5549,"maximum":5549,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5549,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5549,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5549,"methodology":"case rate"}]}]},{"description":"ALTERATION IN CONSCIOUSNESS","code_information":[{"code":"0524","type":"APR-DRG"}],"standard_charges":[{"minimum":13003,"maximum":13003,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13003,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13003,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13003,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"minimum":8398.5,"maximum":27071.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18148,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18148,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27071.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20304.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20304.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19536.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14479.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22348.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8398.5,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8482.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8650.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8566.47,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8398.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8398.5,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8398.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8608.47,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8398.5,"methodology":"case rate"}]}]},{"description":"SEIZURE","code_information":[{"code":"0531","type":"APR-DRG"}],"standard_charges":[{"minimum":3514,"maximum":3514,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3514,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3514,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3514,"methodology":"case rate"}]}]},{"description":"SEIZURE","code_information":[{"code":"0532","type":"APR-DRG"}],"standard_charges":[{"minimum":4288,"maximum":4288,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4288,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4288,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4288,"methodology":"case rate"}]}]},{"description":"SEIZURE","code_information":[{"code":"0533","type":"APR-DRG"}],"standard_charges":[{"minimum":5666,"maximum":5666,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5666,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5666,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5666,"methodology":"case rate"}]}]},{"description":"SEIZURE","code_information":[{"code":"0534","type":"APR-DRG"}],"standard_charges":[{"minimum":14151,"maximum":14151,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14151,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14151,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14151,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM NEOPLASMS WITH MCC","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":12865.87,"maximum":31000.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25173,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25173,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30301.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22726.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22726.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27099.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20085.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31000.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12994.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13251.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13123.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13187.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"}]}]},{"description":"MIGRAINE AND OTHER HEADACHES","code_information":[{"code":"0541","type":"APR-DRG"}],"standard_charges":[{"minimum":3786,"maximum":3786,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3786,"methodology":"case rate"}]}]},{"description":"MIGRAINE AND OTHER HEADACHES","code_information":[{"code":"0542","type":"APR-DRG"}],"standard_charges":[{"minimum":4449,"maximum":4449,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4449,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4449,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4449,"methodology":"case rate"}]}]},{"description":"MIGRAINE AND OTHER HEADACHES","code_information":[{"code":"0543","type":"APR-DRG"}],"standard_charges":[{"minimum":5488,"maximum":5488,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5488,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5488,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5488,"methodology":"case rate"}]}]},{"description":"MIGRAINE AND OTHER HEADACHES","code_information":[{"code":"0544","type":"APR-DRG"}],"standard_charges":[{"minimum":10322,"maximum":10322,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10322,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10322,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10322,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM NEOPLASMS WITHOUT MCC","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"minimum":9710.02,"maximum":23880.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18522,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18522,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23880.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17911.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17911.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19938.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14778.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22809.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9710.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9807.13,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10001.33,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9904.23,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9710.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9710.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9710.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9952.78,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9710.02,"methodology":"case rate"}]}]},{"description":"HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE","code_information":[{"code":"0551","type":"APR-DRG"}],"standard_charges":[{"minimum":4563,"maximum":4563,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4563,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4563,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4563,"methodology":"case rate"}]}]},{"description":"HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE","code_information":[{"code":"0552","type":"APR-DRG"}],"standard_charges":[{"minimum":6207,"maximum":6207,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6207,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6207,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6207,"methodology":"case rate"}]}]},{"description":"HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE","code_information":[{"code":"0553","type":"APR-DRG"}],"standard_charges":[{"minimum":9436,"maximum":9436,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9436,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9436,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9436,"methodology":"case rate"}]}]},{"description":"HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE","code_information":[{"code":"0554","type":"APR-DRG"}],"standard_charges":[{"minimum":19084,"maximum":19084,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19084,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19084,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19084,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"minimum":20117.45,"maximum":50716.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41184,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41184,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26822.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20117.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20117.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":44334.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32859.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50716.78,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20637.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20843.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21256.68,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21050.31,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20637.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20637.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20637.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21153.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20637.55,"methodology":"case rate"}]}]},{"description":"BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0561","type":"APR-DRG"}],"standard_charges":[{"minimum":4139,"maximum":4139,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4139,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4139,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4139,"methodology":"case rate"}]}]},{"description":"BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0562","type":"APR-DRG"}],"standard_charges":[{"minimum":5956,"maximum":5956,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5956,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5956,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5956,"methodology":"case rate"}]}]},{"description":"BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0563","type":"APR-DRG"}],"standard_charges":[{"minimum":9496,"maximum":9496,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9496,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9496,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9496,"methodology":"case rate"}]}]},{"description":"BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0564","type":"APR-DRG"}],"standard_charges":[{"minimum":17802,"maximum":17802,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17802,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17802,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17802,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":11592.24,"maximum":28009.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22744,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22744,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18727.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14045.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14045.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24484.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18147.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28009.43,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11592.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11708.17,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11940.01,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11824.09,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11592.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11592.24,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11592.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11882.05,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11592.24,"methodology":"case rate"}]}]},{"description":"CONCUSSION CLOSED SKULL FRACTURE NOS AND UNCOMPLICATED INTRACRANIAL INJURY COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0571","type":"APR-DRG"}],"standard_charges":[{"minimum":4136,"maximum":4136,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4136,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4136,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4136,"methodology":"case rate"}]}]},{"description":"CONCUSSION CLOSED SKULL FRACTURE NOS AND UNCOMPLICATED INTRACRANIAL INJURY COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0572","type":"APR-DRG"}],"standard_charges":[{"minimum":5712,"maximum":5712,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5712,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5712,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5712,"methodology":"case rate"}]}]},{"description":"CONCUSSION CLOSED SKULL FRACTURE NOS AND UNCOMPLICATED INTRACRANIAL INJURY COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0573","type":"APR-DRG"}],"standard_charges":[{"minimum":7979,"maximum":7979,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7979,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7979,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7979,"methodology":"case rate"}]}]},{"description":"CONCUSSION CLOSED SKULL FRACTURE NOS AND UNCOMPLICATED INTRACRANIAL INJURY COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0574","type":"APR-DRG"}],"standard_charges":[{"minimum":15397,"maximum":15397,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15397,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15397,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15397,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"minimum":15547.68,"maximum":45218.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36719,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36719,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28975.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21732.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21732.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39527.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29297.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45218.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15547.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15703.16,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16014.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15858.64,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15547.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15547.68,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15547.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15936.38,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15547.68,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM","code_information":[{"code":"0581","type":"APR-DRG"}],"standard_charges":[{"minimum":5303,"maximum":5303,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5303,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5303,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5303,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM","code_information":[{"code":"0582","type":"APR-DRG"}],"standard_charges":[{"minimum":7102,"maximum":7102,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7102,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7102,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7102,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM","code_information":[{"code":"0583","type":"APR-DRG"}],"standard_charges":[{"minimum":9213,"maximum":9213,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9213,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9213,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9213,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM","code_information":[{"code":"0584","type":"APR-DRG"}],"standard_charges":[{"minimum":13686,"maximum":13686,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13686,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13686,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13686,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"minimum":10735.42,"maximum":25226.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20485,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20485,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21098.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15824,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15824,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22052.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16344.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25226.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10735.42,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10842.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11057.49,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10950.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10735.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10735.42,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10735.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11003.81,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10735.42,"methodology":"case rate"}]}]},{"description":"ANOXIC AND OTHER SEVERE BRAIN DAMAGE","code_information":[{"code":"0591","type":"APR-DRG"}],"standard_charges":[{"minimum":4053,"maximum":4053,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4053,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4053,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4053,"methodology":"case rate"}]}]},{"description":"ANOXIC AND OTHER SEVERE BRAIN DAMAGE","code_information":[{"code":"0592","type":"APR-DRG"}],"standard_charges":[{"minimum":6416,"maximum":6416,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6416,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6416,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6416,"methodology":"case rate"}]}]},{"description":"ANOXIC AND OTHER SEVERE BRAIN DAMAGE","code_information":[{"code":"0593","type":"APR-DRG"}],"standard_charges":[{"minimum":9361,"maximum":9361,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9361,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9361,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9361,"methodology":"case rate"}]}]},{"description":"ANOXIC AND OTHER SEVERE BRAIN DAMAGE","code_information":[{"code":"0594","type":"APR-DRG"}],"standard_charges":[{"minimum":14622,"maximum":14622,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14622,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14622,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14622,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"minimum":8174.25,"maximum":20396.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16562,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16562,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18661.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13996.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13996.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17829.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13214.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20396.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8174.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8256,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8419.48,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8337.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8174.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8174.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8174.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8378.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8174.25,"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":22178.74,"maximum":64622.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52475,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52475,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62588.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46942.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46942.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":56490.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":41868.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64622.03,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22178.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22400.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22844.11,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22622.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22178.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22178.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22178.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22733.21,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22178.74,"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":15045.03,"maximum":51181.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37780,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37780,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51181.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38386.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38386.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":40670.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30143.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46525.08,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15045.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15195.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15496.39,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15345.94,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15045.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15045.03,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15045.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15421.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15045.03,"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":12136.64,"maximum":45681.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31573,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31573,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45681.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34261.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34261.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33989.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25191.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38881.94,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12136.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12258.01,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12500.74,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12379.38,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12136.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12136.64,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12136.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12440.06,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12136.64,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":16655.82,"maximum":43369.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35218,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35218,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38268.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28701.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28701.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37912.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28099.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43369.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16655.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16822.38,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17155.5,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16988.94,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16655.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16655.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16655.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17072.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16655.82,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":9137.01,"maximum":29439.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19305,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19305,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29439.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22079.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22079.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20782.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15403.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23773.78,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9137.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9228.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9411.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9319.76,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9137.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9137.01,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9137.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9365.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9137.01,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":6595.94,"maximum":24330.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13468,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13468,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24330.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18248.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18248.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14499.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10746.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16586.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6595.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6661.9,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6793.82,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6727.86,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6595.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6595.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6595.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6760.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6595.94,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"minimum":12524.07,"maximum":33878.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27510,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27510,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22219.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16665.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16665.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29615.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21949.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33878.27,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12524.07,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12649.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12899.8,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12774.56,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12524.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12524.07,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12524.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12837.18,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12524.07,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"minimum":8089.96,"maximum":20898.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16970,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16970,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16637.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12478.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12478.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18268.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13540.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20898.35,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8089.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8170.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8332.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8251.76,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8089.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8089.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8089.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8292.21,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8089.96,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"minimum":7460.49,"maximum":18050.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14657,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14657,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17917.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13438.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13438.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15779.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11695.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18050.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7460.49,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7535.1,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7684.31,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7609.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7460.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7460.49,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7460.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7647.01,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7460.49,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"minimum":14719.47,"maximum":38699.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31425,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31425,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31855.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23891.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23891.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33829.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25073.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38699.19,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14719.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14866.67,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15161.06,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15013.86,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14719.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14719.47,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14719.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15087.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14719.47,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":9423.13,"maximum":24604.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18685,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18685,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24604.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18453.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18453.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20114.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14908.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23010.39,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9423.13,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9517.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9705.83,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9611.6,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9423.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9423.13,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9423.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9658.71,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9423.13,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"minimum":7074.61,"maximum":18834.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13872,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13872,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18834.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14126.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14126.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14933.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11068.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17083.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7145.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7286.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7216.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.61,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7251.48,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.61,"methodology":"case rate"}]}]},{"description":"CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"minimum":13225.45,"maximum":32747.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26592,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26592,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24019.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18014.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18014.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28626.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21217.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32747.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13225.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13357.71,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13622.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13489.96,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13225.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13225.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13225.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13556.09,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13225.45,"methodology":"case rate"}]}]},{"description":"ORBIT AND EYE PROCEDURES","code_information":[{"code":"0731","type":"APR-DRG"}],"standard_charges":[{"minimum":5957,"maximum":5957,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5957,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5957,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5957,"methodology":"case rate"}]}]},{"description":"ORBIT AND EYE PROCEDURES","code_information":[{"code":"0732","type":"APR-DRG"}],"standard_charges":[{"minimum":8463,"maximum":8463,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8463,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8463,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8463,"methodology":"case rate"}]}]},{"description":"ORBIT AND EYE PROCEDURES","code_information":[{"code":"0733","type":"APR-DRG"}],"standard_charges":[{"minimum":14400,"maximum":14400,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14400,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14400,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14400,"methodology":"case rate"}]}]},{"description":"ORBIT AND EYE PROCEDURES","code_information":[{"code":"0734","type":"APR-DRG"}],"standard_charges":[{"minimum":27338,"maximum":27338,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27338,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27338,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27338,"methodology":"case rate"}]}]},{"description":"CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":9334.2,"maximum":22857.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18561,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18561,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18357.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13768.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13768.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19981.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14809.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22857.71,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9334.2,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9427.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9614.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9520.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9334.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9334.2,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9334.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9567.56,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9334.2,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS WITH CC/MCC","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"minimum":14592.65,"maximum":37202.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30210,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30210,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23624.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17718.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17718.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32521.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24103.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37202.49,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14592.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14738.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15030.43,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14884.51,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14592.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14592.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14592.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14957.47,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14592.65,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS WITHOUT CC/MCC","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"minimum":8363.7,"maximum":20877.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16953,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16953,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17585.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13189.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13189.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18250.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13526.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20877.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8363.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8447.34,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8614.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8530.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8363.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8363.7,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8363.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8572.8,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8363.7,"methodology":"case rate"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITH MCC","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"minimum":13230.87,"maximum":35682.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28975,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28975,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21534.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16151.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16151.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31192.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23118.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35682.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13230.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13363.18,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13627.8,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13495.49,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13230.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13230.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13230.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13561.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13230.87,"methodology":"case rate"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITH CC","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"minimum":8990.08,"maximum":22253.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18071,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18071,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17107.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12831.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12831.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19453.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14418.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22253.94,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9079.99,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9259.79,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9169.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9214.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.08,"methodology":"case rate"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"minimum":6428.9,"maximum":43117.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13921,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13921,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43117.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32338.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32338.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14986.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11107.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17143.86,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6428.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6493.19,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6621.77,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6557.48,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6428.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6428.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6428.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6589.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6428.9,"methodology":"case rate"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITH MCC","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"minimum":16644.99,"maximum":44329.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35997,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35997,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34364.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25773.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25773.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38751.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28721.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44329.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16644.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16811.44,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17144.34,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16977.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16644.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16644.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16644.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17061.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16644.99,"methodology":"case rate"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"minimum":8270.14,"maximum":28632.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16513,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16513,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28632.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21475.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21475.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17777.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13175.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20336.22,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8270.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8352.85,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8518.25,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8435.55,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8270.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8270.14,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8270.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8476.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8270.14,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"minimum":19215.45,"maximum":52090.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42300,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42300,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37371.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28029.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28029.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45535.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":33749.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52090.88,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19215.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19407.61,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19791.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19599.76,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19215.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19215.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19215.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19695.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19215.45,"methodology":"case rate"}]}]},{"description":"EYE INFECTIONS AND OTHER EYE DISORDERS","code_information":[{"code":"0821","type":"APR-DRG"}],"standard_charges":[{"minimum":3645,"maximum":3645,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3645,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3645,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3645,"methodology":"case rate"}]}]},{"description":"EYE INFECTIONS AND OTHER EYE DISORDERS","code_information":[{"code":"0822","type":"APR-DRG"}],"standard_charges":[{"minimum":4446,"maximum":4446,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4446,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4446,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4446,"methodology":"case rate"}]}]},{"description":"EYE INFECTIONS AND OTHER EYE DISORDERS","code_information":[{"code":"0823","type":"APR-DRG"}],"standard_charges":[{"minimum":6817,"maximum":6817,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6817,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6817,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6817,"methodology":"case rate"}]}]},{"description":"EYE INFECTIONS AND OTHER EYE DISORDERS","code_information":[{"code":"0824","type":"APR-DRG"}],"standard_charges":[{"minimum":15858,"maximum":15858,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15858,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15858,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"minimum":12025.29,"maximum":30320.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24621,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24621,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27206.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20405.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20405.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26504.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19644.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30320.42,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12025.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12145.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12386.05,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12265.8,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12025.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12025.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12025.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12325.93,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12025.29,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"minimum":8666.84,"maximum":20757.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16855,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16855,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20364.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15273.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15273.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18145.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13448.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20757.24,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8666.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8753.51,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8926.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8840.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8666.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8666.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8666.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8883.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8666.84,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"minimum":17900.64,"maximum":51952.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42187,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42187,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23867.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17900.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17900.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45414.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":33660.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51952.09,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18796.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18984.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19360.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19172.25,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18796.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18796.32,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18796.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19266.23,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18796.32,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"minimum":11415.93,"maximum":28634.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23252,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23252,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17443.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13082.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13082.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25030.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18552.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28634.02,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11415.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11530.09,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11758.41,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11644.25,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11415.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11415.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11415.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11701.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11415.93,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"minimum":8109.29,"maximum":19413.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15764,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15764,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14307.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10731.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10731.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16970.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12577.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19413.21,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8109.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8190.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8352.57,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8271.48,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8109.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8109.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8109.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8312.03,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8109.29,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITH MCC","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"minimum":12182.27,"maximum":32134.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26094,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26094,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26739.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20055.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20055.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28090.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20819.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32134.05,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12182.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12304.1,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12547.74,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12425.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12182.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12182.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12182.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12486.83,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12182.27,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITH CC","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"minimum":9563.87,"maximum":22816.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18527,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18527,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19239.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14430.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14430.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19944.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14782.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22816.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9563.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9659.51,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9850.79,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9755.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9563.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9563.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9563.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9802.97,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9563.87,"methodology":"case rate"}]}]},{"description":"MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0891","type":"APR-DRG"}],"standard_charges":[{"minimum":10452,"maximum":10452,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10452,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10452,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10452,"methodology":"case rate"}]}]},{"description":"MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0892","type":"APR-DRG"}],"standard_charges":[{"minimum":13665,"maximum":13665,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13665,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13665,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13665,"methodology":"case rate"}]}]},{"description":"MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0893","type":"APR-DRG"}],"standard_charges":[{"minimum":24002,"maximum":24002,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24002,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24002,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24002,"methodology":"case rate"}]}]},{"description":"MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0894","type":"APR-DRG"}],"standard_charges":[{"minimum":40446,"maximum":40446,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40446,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40446,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40446,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITHOUT CC/MCC","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"minimum":7902.82,"maximum":19623.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15935,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15935,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15567.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11675.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11675.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17154.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12714.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19623.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7902.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7981.85,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8139.91,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8060.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7902.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7902.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7902.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8100.4,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7902.82,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":15369.82,"maximum":59297.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29400,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29400,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59297.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44473.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44473.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31649.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23457.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36205.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15369.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15523.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15830.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15677.22,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15369.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15369.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15369.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15754.07,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15369.82,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR HEAD AND NECK PROCEDURES","code_information":[{"code":"0911","type":"APR-DRG"}],"standard_charges":[{"minimum":9201,"maximum":9201,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9201,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9201,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9201,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR HEAD AND NECK PROCEDURES","code_information":[{"code":"0912","type":"APR-DRG"}],"standard_charges":[{"minimum":13801,"maximum":13801,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13801,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13801,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13801,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR HEAD AND NECK PROCEDURES","code_information":[{"code":"0913","type":"APR-DRG"}],"standard_charges":[{"minimum":24203,"maximum":24203,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24203,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24203,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24203,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR HEAD AND NECK PROCEDURES","code_information":[{"code":"0914","type":"APR-DRG"}],"standard_charges":[{"minimum":40663,"maximum":40663,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40663,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40663,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40663,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITH CC","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":9460.25,"maximum":48339.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18148,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18148,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48339.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36255.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36255.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19536.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14479.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22348.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9460.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9554.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9744.06,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9649.46,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9460.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9460.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9460.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9696.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9460.25,"methodology":"case rate"}]}]},{"description":"FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0921","type":"APR-DRG"}],"standard_charges":[{"minimum":8540,"maximum":8540,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8540,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8540,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8540,"methodology":"case rate"}]}]},{"description":"FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0922","type":"APR-DRG"}],"standard_charges":[{"minimum":10881,"maximum":10881,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10881,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10881,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10881,"methodology":"case rate"}]}]},{"description":"FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0923","type":"APR-DRG"}],"standard_charges":[{"minimum":17089,"maximum":17089,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17089,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17089,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17089,"methodology":"case rate"}]}]},{"description":"FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0924","type":"APR-DRG"}],"standard_charges":[{"minimum":30677,"maximum":30677,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30677,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30677,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30677,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":7376.97,"maximum":44203.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14299,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14299,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44203.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33153.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33153.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15392.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11408.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17608.83,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7376.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7450.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7598.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7524.51,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7376.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7376.97,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7376.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7561.4,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7376.97,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"minimum":29488.77,"maximum":82927.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67340,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67340,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46128.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34596.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34596.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":72491.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":53728.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82927.17,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29488.77,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29783.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30373.44,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30078.55,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29488.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29488.77,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29488.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30225.99,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29488.77,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"minimum":19810.89,"maximum":55683.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45217,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45217,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35582.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26687.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26687.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":48676.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36077.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":55683.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20009,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20405.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20207.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20306.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"}]}]},{"description":"CLEFT LIP AND PALATE REPAIR","code_information":[{"code":"0951","type":"APR-DRG"}],"standard_charges":[{"minimum":4848,"maximum":4848,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4848,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4848,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4848,"methodology":"case rate"}]}]},{"description":"CLEFT LIP AND PALATE REPAIR","code_information":[{"code":"0952","type":"APR-DRG"}],"standard_charges":[{"minimum":5284,"maximum":5284,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5284,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5284,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5284,"methodology":"case rate"}]}]},{"description":"CLEFT LIP AND PALATE REPAIR","code_information":[{"code":"0953","type":"APR-DRG"}],"standard_charges":[{"minimum":8203,"maximum":8203,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8203,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8203,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8203,"methodology":"case rate"}]}]},{"description":"CLEFT LIP AND PALATE REPAIR","code_information":[{"code":"0954","type":"APR-DRG"}],"standard_charges":[{"minimum":18375,"maximum":18375,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18375,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18375,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18375,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"minimum":19810.89,"maximum":52329.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42493,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42493,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31443.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23582.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23582.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45744.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":33904.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52329.15,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20009,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20405.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20207.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20306.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19810.89,"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":18025.24,"maximum":82721.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67173,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67173,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24033.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18025.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18025.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":72311.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":53595.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82721.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28993.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29283.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29862.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29572.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28993.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28993.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28993.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29717.91,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28993.08,"methodology":"case rate"}]}]},{"description":"TONSIL AND ADENOID PROCEDURES","code_information":[{"code":"0971","type":"APR-DRG"}],"standard_charges":[{"minimum":3601,"maximum":3601,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3601,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3601,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3601,"methodology":"case rate"}]}]},{"description":"TONSIL AND ADENOID PROCEDURES","code_information":[{"code":"0972","type":"APR-DRG"}],"standard_charges":[{"minimum":5250,"maximum":5250,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5250,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5250,"methodology":"case rate"}]}]},{"description":"TONSIL AND ADENOID PROCEDURES","code_information":[{"code":"0973","type":"APR-DRG"}],"standard_charges":[{"minimum":9184,"maximum":9184,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9184,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9184,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9184,"methodology":"case rate"}]}]},{"description":"TONSIL AND ADENOID PROCEDURES","code_information":[{"code":"0974","type":"APR-DRG"}],"standard_charges":[{"minimum":16337,"maximum":16337,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16337,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16337,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16337,"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":11906.93,"maximum":45225.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36724,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36724,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15875.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11906.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11906.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39534.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29301.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45225.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18048.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18229.03,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18590,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18409.52,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18048.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18048.54,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18048.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18499.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18048.54,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT PROCEDURES","code_information":[{"code":"0981","type":"APR-DRG"}],"standard_charges":[{"minimum":5899,"maximum":5899,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5899,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5899,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5899,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT PROCEDURES","code_information":[{"code":"0982","type":"APR-DRG"}],"standard_charges":[{"minimum":8339,"maximum":8339,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8339,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8339,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT PROCEDURES","code_information":[{"code":"0983","type":"APR-DRG"}],"standard_charges":[{"minimum":14321,"maximum":14321,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14321,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14321,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14321,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT PROCEDURES","code_information":[{"code":"0984","type":"APR-DRG"}],"standard_charges":[{"minimum":26356,"maximum":26356,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26356,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26356,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26356,"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":12047.72,"maximum":29665.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24089,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24089,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17118.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12838.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12838.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25932.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19220.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29665.75,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12047.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12168.2,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12409.16,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12288.68,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12047.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12047.72,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12047.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12348.92,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12047.72,"methodology":"case rate"}]}]},{"description":"SEIZURES WITH MCC","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":9843.27,"maximum":42106.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34192,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34192,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13124.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9843.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9843.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":36808.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27281.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42106.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16625.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16791.92,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17124.43,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16958.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16625.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16625.66,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16625.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17041.31,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16625.66,"methodology":"case rate"}]}]},{"description":"SEIZURES WITHOUT MCC","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":8400.82,"maximum":25216.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16585,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16585,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25216.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18913,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18913,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17854,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13232.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20424.12,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8400.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8484.83,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8652.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8568.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8400.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8400.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8400.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8610.85,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8400.82,"methodology":"case rate"}]}]},{"description":"HEADACHES WITH MCC","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"minimum":10239.74,"maximum":27588.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22402,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22402,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18350.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13762.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13762.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24116.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17874.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27588.41,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10239.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10342.14,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10546.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10444.54,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10239.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10239.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10239.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10495.74,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10239.74,"methodology":"case rate"}]}]},{"description":"HEADACHES WITHOUT MCC","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"minimum":7847.91,"maximum":18855.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15018,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15018,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18855.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14141.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14141.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16167.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11982.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18494.83,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7847.91,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7926.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8083.35,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8004.87,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7847.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7847.91,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7847.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8044.11,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7847.91,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL MALIGNANCIES","code_information":[{"code":"1101","type":"APR-DRG"}],"standard_charges":[{"minimum":4668,"maximum":4668,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4668,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4668,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4668,"methodology":"case rate"}]}]},{"description":"ROOM PVT GENERAL","code_information":[{"code":"1101000923","type":"CDM"},{"code":"0110","type":"RC"}],"standard_charges":[{"minimum":1068.78,"maximum":2303.94,"gross_charge":2820,"discounted_cash":645.78,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1068.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1068.78,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1494.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2303.94,"methodology":"fee schedule"}]}]},{"description":"EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL MALIGNANCIES","code_information":[{"code":"1102","type":"APR-DRG"}],"standard_charges":[{"minimum":5674,"maximum":5674,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5674,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5674,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5674,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL MALIGNANCIES","code_information":[{"code":"1103","type":"APR-DRG"}],"standard_charges":[{"minimum":8680,"maximum":8680,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8680,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8680,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8680,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL MALIGNANCIES","code_information":[{"code":"1104","type":"APR-DRG"}],"standard_charges":[{"minimum":14780,"maximum":14780,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14780,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14780,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14780,"methodology":"case rate"}]}]},{"description":"VERTIGO AND OTHER LABYRINTH DISORDERS","code_information":[{"code":"1111","type":"APR-DRG"}],"standard_charges":[{"minimum":3649,"maximum":3649,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3649,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3649,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3649,"methodology":"case rate"}]}]},{"description":"VERTIGO AND OTHER LABYRINTH DISORDERS","code_information":[{"code":"1112","type":"APR-DRG"}],"standard_charges":[{"minimum":4030,"maximum":4030,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4030,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4030,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4030,"methodology":"case rate"}]}]},{"description":"VERTIGO AND OTHER LABYRINTH DISORDERS","code_information":[{"code":"1113","type":"APR-DRG"}],"standard_charges":[{"minimum":5077,"maximum":5077,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5077,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5077,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5077,"methodology":"case rate"}]}]},{"description":"VERTIGO AND OTHER LABYRINTH DISORDERS","code_information":[{"code":"1114","type":"APR-DRG"}],"standard_charges":[{"minimum":6636,"maximum":6636,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6636,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6636,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6636,"methodology":"case rate"}]}]},{"description":"ORBITAL PROCEDURES WITH CC/MCC","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"minimum":14217.2,"maximum":43985.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40051,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40051,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18955.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14217.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14217.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38750.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31955.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43985.22,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18723.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18910.87,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19285.34,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19098.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18723.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18723.63,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18723.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19191.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18723.63,"methodology":"case rate"}]}]},{"description":"INFECTIONS OF UPPER RESPIRATORY TRACT","code_information":[{"code":"1131","type":"APR-DRG"}],"standard_charges":[{"minimum":2300,"maximum":2300,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2300,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2300,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2300,"methodology":"case rate"}]}]},{"description":"INFECTIONS OF UPPER RESPIRATORY TRACT","code_information":[{"code":"1132","type":"APR-DRG"}],"standard_charges":[{"minimum":3194,"maximum":3194,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3194,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3194,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3194,"methodology":"case rate"}]}]},{"description":"INFECTIONS OF UPPER RESPIRATORY TRACT","code_information":[{"code":"1133","type":"APR-DRG"}],"standard_charges":[{"minimum":4672,"maximum":4672,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4672,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4672,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4672,"methodology":"case rate"}]}]},{"description":"INFECTIONS OF UPPER RESPIRATORY TRACT","code_information":[{"code":"1134","type":"APR-DRG"}],"standard_charges":[{"minimum":8946,"maximum":8946,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8946,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8946,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8946,"methodology":"case rate"}]}]},{"description":"ORBITAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"minimum":10414.5,"maximum":24566.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22369,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22369,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15124.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11343.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11343.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21642.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17847.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24566.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10414.5,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10518.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10726.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10622.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10414.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10414.5,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10414.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10674.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10414.5,"methodology":"case rate"}]}]},{"description":"DENTAL DISEASES AND DISORDERS","code_information":[{"code":"1141","type":"APR-DRG"}],"standard_charges":[{"minimum":2705,"maximum":2705,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2705,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2705,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2705,"methodology":"case rate"}]}]},{"description":"DENTAL DISEASES AND DISORDERS","code_information":[{"code":"1142","type":"APR-DRG"}],"standard_charges":[{"minimum":3681,"maximum":3681,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3681,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3681,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3681,"methodology":"case rate"}]}]},{"description":"DENTAL DISEASES AND DISORDERS","code_information":[{"code":"1143","type":"APR-DRG"}],"standard_charges":[{"minimum":6192,"maximum":6192,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6192,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6192,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6192,"methodology":"case rate"}]}]},{"description":"DENTAL DISEASES AND DISORDERS","code_information":[{"code":"1144","type":"APR-DRG"}],"standard_charges":[{"minimum":15116,"maximum":15116,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15116,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15116,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15116,"methodology":"case rate"}]}]},{"description":"EXTRAOCULAR PROCEDURES EXCEPT ORBIT","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"minimum":12039.32,"maximum":30656.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27914,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27914,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16052.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12039.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12039.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27008.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22272.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30656.18,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13112.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13243.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13505.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13374.81,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13112.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13112.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13112.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13440.37,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13112.55,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL DIAGNOSES","code_information":[{"code":"1151","type":"APR-DRG"}],"standard_charges":[{"minimum":3262,"maximum":3262,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3262,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3262,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3262,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL DIAGNOSES","code_information":[{"code":"1152","type":"APR-DRG"}],"standard_charges":[{"minimum":4340,"maximum":4340,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4340,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4340,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4340,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL DIAGNOSES","code_information":[{"code":"1153","type":"APR-DRG"}],"standard_charges":[{"minimum":6831,"maximum":6831,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6831,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6831,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6831,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL DIAGNOSES","code_information":[{"code":"1154","type":"APR-DRG"}],"standard_charges":[{"minimum":12897,"maximum":12897,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12897,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12897,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12897,"methodology":"case rate"}]}]},{"description":"INTRAOCULAR PROCEDURES WITH CC/MCC","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"minimum":9041.17,"maximum":39011.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35522,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35522,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12054.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9041.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9041.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34368.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28342.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39011.33,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14176.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14318.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14601.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14460.16,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14176.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14176.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14176.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14531.04,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14176.62,"methodology":"case rate"}]}]},{"description":"INTRAOCULAR PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"minimum":9614.13,"maximum":22624.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20601,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20601,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18952.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14214.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14214.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19932.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16437.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22624.92,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9614.13,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9710.28,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9902.56,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9806.42,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9614.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9614.13,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9614.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9854.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9614.13,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1201","type":"APR-DRG"}],"standard_charges":[{"minimum":10919,"maximum":10919,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10919,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10919,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10919,"methodology":"case rate"}]}]},{"description":"ROOM SEMI GENERAL","code_information":[{"code":"1201000924","type":"CDM"},{"code":"0120","type":"RC"}],"standard_charges":[{"minimum":1068.78,"maximum":2303.94,"gross_charge":2820,"discounted_cash":645.78,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1068.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1068.78,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1494.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2303.94,"methodology":"fee schedule"}]}]},{"description":"MAJOR RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1202","type":"APR-DRG"}],"standard_charges":[{"minimum":13550,"maximum":13550,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13550,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13550,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13550,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1203","type":"APR-DRG"}],"standard_charges":[{"minimum":20637,"maximum":20637,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20637,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20637,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20637,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1204","type":"APR-DRG"}],"standard_charges":[{"minimum":36118,"maximum":36118,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36118,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36118,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36118,"methodology":"case rate"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITH CC/MCC","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"minimum":10268.35,"maximum":26154.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23815,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23815,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15128.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11346.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11346.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23042.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19001.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26154.71,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10268.35,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10371.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10576.41,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10473.72,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10268.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10268.35,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10268.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10525.06,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10268.35,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1211","type":"APR-DRG"}],"standard_charges":[{"minimum":8077,"maximum":8077,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8077,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8077,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8077,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1212","type":"APR-DRG"}],"standard_charges":[{"minimum":10983,"maximum":10983,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10983,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10983,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10983,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1213","type":"APR-DRG"}],"standard_charges":[{"minimum":17097,"maximum":17097,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17097,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17097,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17097,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1214","type":"APR-DRG"}],"standard_charges":[{"minimum":29557,"maximum":29557,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29557,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29557,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29557,"methodology":"case rate"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"minimum":6518.61,"maximum":15938.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14513,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14513,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11037.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8278.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8278.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14042,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11579.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15938.73,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6518.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6583.8,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6714.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6648.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6518.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6518.61,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6518.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6681.58,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6518.61,"methodology":"case rate"}]}]},{"description":"NEUROLOGICAL EYE DISORDERS","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"minimum":7484.46,"maximum":30065.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14667,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14667,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30065.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22549.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22549.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15789.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11702.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18062.25,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7484.46,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7559.31,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7709,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7634.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7484.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7484.46,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7484.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7671.58,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7484.46,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"minimum":11356.38,"maximum":28663.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26099,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26099,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21773.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16330.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16330.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25252.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20824.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28663.32,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11356.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11469.95,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11697.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11583.51,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11356.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11356.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11356.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11640.29,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11356.38,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITHOUT MCC","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"minimum":7658.45,"maximum":22939.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14828,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14828,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22939.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17204.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17204.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14347.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11831.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16285.32,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7658.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7735.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7811.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7658.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7658.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7658.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7849.92,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7658.45,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS","code_information":[{"code":"1301","type":"APR-DRG"}],"standard_charges":[{"minimum":18134,"maximum":18134,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18134,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18134,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18134,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS","code_information":[{"code":"1302","type":"APR-DRG"}],"standard_charges":[{"minimum":21538,"maximum":21538,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21538,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21538,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21538,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS","code_information":[{"code":"1303","type":"APR-DRG"}],"standard_charges":[{"minimum":25327,"maximum":25327,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25327,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25327,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25327,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS","code_information":[{"code":"1304","type":"APR-DRG"}],"standard_charges":[{"minimum":33998,"maximum":33998,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33998,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33998,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33998,"methodology":"case rate"}]}]},{"description":"CYSTIC FIBROSIS - PULMONARY DISEASE","code_information":[{"code":"1311","type":"APR-DRG"}],"standard_charges":[{"minimum":7929,"maximum":7929,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7929,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7929,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7929,"methodology":"case rate"}]}]},{"description":"CYSTIC FIBROSIS - PULMONARY DISEASE","code_information":[{"code":"1312","type":"APR-DRG"}],"standard_charges":[{"minimum":9764,"maximum":9764,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9764,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9764,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9764,"methodology":"case rate"}]}]},{"description":"CYSTIC FIBROSIS - PULMONARY DISEASE","code_information":[{"code":"1313","type":"APR-DRG"}],"standard_charges":[{"minimum":13265,"maximum":13265,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13265,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13265,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13265,"methodology":"case rate"}]}]},{"description":"CYSTIC FIBROSIS - PULMONARY DISEASE","code_information":[{"code":"1314","type":"APR-DRG"}],"standard_charges":[{"minimum":17604,"maximum":17604,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17604,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17604,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17604,"methodology":"case rate"}]}]},{"description":"BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD","code_information":[{"code":"1321","type":"APR-DRG"}],"standard_charges":[{"minimum":3018,"maximum":3018,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3018,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3018,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3018,"methodology":"case rate"}]}]},{"description":"BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD","code_information":[{"code":"1322","type":"APR-DRG"}],"standard_charges":[{"minimum":4001,"maximum":4001,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4001,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4001,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4001,"methodology":"case rate"}]}]},{"description":"BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD","code_information":[{"code":"1323","type":"APR-DRG"}],"standard_charges":[{"minimum":6682,"maximum":6682,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6682,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6682,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6682,"methodology":"case rate"}]}]},{"description":"BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD","code_information":[{"code":"1324","type":"APR-DRG"}],"standard_charges":[{"minimum":11625,"maximum":11625,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11625,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11625,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11625,"methodology":"case rate"}]}]},{"description":"RESPIRATORY FAILURE","code_information":[{"code":"1331","type":"APR-DRG"}],"standard_charges":[{"minimum":2669,"maximum":2669,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2669,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2669,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2669,"methodology":"case rate"}]}]},{"description":"RESPIRATORY FAILURE","code_information":[{"code":"1332","type":"APR-DRG"}],"standard_charges":[{"minimum":4405,"maximum":4405,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4405,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4405,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4405,"methodology":"case rate"}]}]},{"description":"RESPIRATORY FAILURE","code_information":[{"code":"1333","type":"APR-DRG"}],"standard_charges":[{"minimum":6733,"maximum":6733,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"}]}]},{"description":"RESPIRATORY FAILURE","code_information":[{"code":"1334","type":"APR-DRG"}],"standard_charges":[{"minimum":11816,"maximum":11816,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11816,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11816,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11816,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM","code_information":[{"code":"1341","type":"APR-DRG"}],"standard_charges":[{"minimum":3584,"maximum":3584,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3584,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3584,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3584,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM","code_information":[{"code":"1342","type":"APR-DRG"}],"standard_charges":[{"minimum":4755,"maximum":4755,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4755,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4755,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4755,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM","code_information":[{"code":"1343","type":"APR-DRG"}],"standard_charges":[{"minimum":7088,"maximum":7088,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7088,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7088,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7088,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM","code_information":[{"code":"1344","type":"APR-DRG"}],"standard_charges":[{"minimum":10836,"maximum":10836,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10836,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10836,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10836,"methodology":"case rate"}]}]},{"description":"SINUS AND MASTOID PROCEDURES WITH CC/MCC","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"minimum":11499.39,"maximum":47131.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42916,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42916,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15332.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11499.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11499.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":41522.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34241.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47131.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19918.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20117.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20515.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20316.75,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19918.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19918.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19918.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20416.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19918.38,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST AND RESPIRATORY TRAUMA","code_information":[{"code":"1351","type":"APR-DRG"}],"standard_charges":[{"minimum":4597,"maximum":4597,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4597,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4597,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4597,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST AND RESPIRATORY TRAUMA","code_information":[{"code":"1352","type":"APR-DRG"}],"standard_charges":[{"minimum":5377,"maximum":5377,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5377,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5377,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5377,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST AND RESPIRATORY TRAUMA","code_information":[{"code":"1353","type":"APR-DRG"}],"standard_charges":[{"minimum":7631,"maximum":7631,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7631,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7631,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7631,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST AND RESPIRATORY TRAUMA","code_information":[{"code":"1354","type":"APR-DRG"}],"standard_charges":[{"minimum":13231,"maximum":13231,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13231,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13231,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13231,"methodology":"case rate"}]}]},{"description":"SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"minimum":8837.74,"maximum":24549.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22354,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22354,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16837.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12628.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12628.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21628.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17835.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24549.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8837.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8926.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9102.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9014.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8837.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8837.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8837.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9058.69,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8837.74,"methodology":"case rate"}]}]},{"description":"RESPIRATORY MALIGNANCY","code_information":[{"code":"1361","type":"APR-DRG"}],"standard_charges":[{"minimum":4492,"maximum":4492,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4492,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4492,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4492,"methodology":"case rate"}]}]},{"description":"RESPIRATORY MALIGNANCY","code_information":[{"code":"1362","type":"APR-DRG"}],"standard_charges":[{"minimum":5877,"maximum":5877,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877,"methodology":"case rate"}]}]},{"description":"RESPIRATORY MALIGNANCY","code_information":[{"code":"1363","type":"APR-DRG"}],"standard_charges":[{"minimum":8333,"maximum":8333,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8333,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8333,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8333,"methodology":"case rate"}]}]},{"description":"RESPIRATORY MALIGNANCY","code_information":[{"code":"1364","type":"APR-DRG"}],"standard_charges":[{"minimum":12324,"maximum":12324,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12324,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12324,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12324,"methodology":"case rate"}]}]},{"description":"MOUTH PROCEDURES WITH CC/MCC","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"minimum":12088.7,"maximum":69455.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25046,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25046,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69455.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52092.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52092.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24232.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19983.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27505.97,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12088.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12209.59,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12451.37,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12330.48,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12088.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12088.7,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12088.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12390.92,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12088.7,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS","code_information":[{"code":"1371","type":"APR-DRG"}],"standard_charges":[{"minimum":3794,"maximum":3794,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS","code_information":[{"code":"1372","type":"APR-DRG"}],"standard_charges":[{"minimum":4970,"maximum":4970,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4970,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4970,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4970,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS","code_information":[{"code":"1373","type":"APR-DRG"}],"standard_charges":[{"minimum":7008,"maximum":7008,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7008,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7008,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7008,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS","code_information":[{"code":"1374","type":"APR-DRG"}],"standard_charges":[{"minimum":10298,"maximum":10298,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10298,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10298,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10298,"methodology":"case rate"}]}]},{"description":"MOUTH PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"minimum":7564.11,"maximum":38687.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16181,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16181,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38687.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29015.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29015.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15655.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12910.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17770.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7564.11,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7639.76,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7791.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7715.4,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7564.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7564.11,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7564.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7753.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7564.11,"methodology":"case rate"}]}]},{"description":"BRONCHIOLITIS AND RSV PNEUMONIA","code_information":[{"code":"1381","type":"APR-DRG"}],"standard_charges":[{"minimum":2045,"maximum":2045,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2045,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2045,"methodology":"case rate"}]}]},{"description":"BRONCHIOLITIS AND RSV PNEUMONIA","code_information":[{"code":"1382","type":"APR-DRG"}],"standard_charges":[{"minimum":3040,"maximum":3040,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3040,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3040,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3040,"methodology":"case rate"}]}]},{"description":"BRONCHIOLITIS AND RSV PNEUMONIA","code_information":[{"code":"1383","type":"APR-DRG"}],"standard_charges":[{"minimum":5157,"maximum":5157,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5157,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5157,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5157,"methodology":"case rate"}]}]},{"description":"BRONCHIOLITIS AND RSV PNEUMONIA","code_information":[{"code":"1384","type":"APR-DRG"}],"standard_charges":[{"minimum":12058,"maximum":12058,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12058,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12058,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12058,"methodology":"case rate"}]}]},{"description":"SALIVARY GLAND PROCEDURES","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"minimum":11890.73,"maximum":28148.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23186,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23186,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28148.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21111.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21111.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22433.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18499.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25463.6,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11890.73,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12009.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12247.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12128.55,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11890.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11890.73,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11890.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12188,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11890.73,"methodology":"case rate"}]}]},{"description":"OTHER PNEUMONIA","code_information":[{"code":"1391","type":"APR-DRG"}],"standard_charges":[{"minimum":2833,"maximum":2833,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2833,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2833,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2833,"methodology":"case rate"}]}]},{"description":"OTHER PNEUMONIA","code_information":[{"code":"1392","type":"APR-DRG"}],"standard_charges":[{"minimum":3816,"maximum":3816,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3816,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3816,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3816,"methodology":"case rate"}]}]},{"description":"OTHER PNEUMONIA","code_information":[{"code":"1393","type":"APR-DRG"}],"standard_charges":[{"minimum":5461,"maximum":5461,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5461,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5461,"methodology":"case rate"}]}]},{"description":"OTHER PNEUMONIA","code_information":[{"code":"1394","type":"APR-DRG"}],"standard_charges":[{"minimum":8747,"maximum":8747,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITH MCC","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"minimum":33977.78,"maximum":51229.72,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51229.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38423.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38423.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33977.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34317.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34997.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34657.34,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33977.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33977.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33977.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34827.23,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33977.78,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE","code_information":[{"code":"1401","type":"APR-DRG"}],"standard_charges":[{"minimum":3250,"maximum":3250,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3250,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3250,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE","code_information":[{"code":"1402","type":"APR-DRG"}],"standard_charges":[{"minimum":4059,"maximum":4059,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4059,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4059,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4059,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE","code_information":[{"code":"1403","type":"APR-DRG"}],"standard_charges":[{"minimum":5063,"maximum":5063,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5063,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5063,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5063,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE","code_information":[{"code":"1404","type":"APR-DRG"}],"standard_charges":[{"minimum":8008,"maximum":8008,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8008,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8008,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8008,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITH CC","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"minimum":17887.69,"maximum":30335.66,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30335.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22752.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22752.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17887.69,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18066.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18424.33,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18245.45,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17887.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17887.69,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17887.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18334.89,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17887.69,"methodology":"case rate"}]}]},{"description":"ASTHMA","code_information":[{"code":"1411","type":"APR-DRG"}],"standard_charges":[{"minimum":2606,"maximum":2606,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2606,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2606,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2606,"methodology":"case rate"}]}]},{"description":"ASTHMA","code_information":[{"code":"1412","type":"APR-DRG"}],"standard_charges":[{"minimum":3789,"maximum":3789,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3789,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3789,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3789,"methodology":"case rate"}]}]},{"description":"ASTHMA","code_information":[{"code":"1413","type":"APR-DRG"}],"standard_charges":[{"minimum":4556,"maximum":4556,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4556,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4556,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4556,"methodology":"case rate"}]}]},{"description":"ASTHMA","code_information":[{"code":"1414","type":"APR-DRG"}],"standard_charges":[{"minimum":8571,"maximum":8571,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8571,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8571,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8571,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"minimum":13432.7,"maximum":21077.49,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21077.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15808.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15808.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13432.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13567.03,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13835.69,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13701.36,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13432.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13432.7,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13432.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13768.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13432.7,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL AND ALVEOLAR LUNG DISEASES","code_information":[{"code":"1421","type":"APR-DRG"}],"standard_charges":[{"minimum":3836,"maximum":3836,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3836,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3836,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3836,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL AND ALVEOLAR LUNG DISEASES","code_information":[{"code":"1422","type":"APR-DRG"}],"standard_charges":[{"minimum":4964,"maximum":4964,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4964,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4964,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4964,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL AND ALVEOLAR LUNG DISEASES","code_information":[{"code":"1423","type":"APR-DRG"}],"standard_charges":[{"minimum":6807,"maximum":6807,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6807,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6807,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6807,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL AND ALVEOLAR LUNG DISEASES","code_information":[{"code":"1424","type":"APR-DRG"}],"standard_charges":[{"minimum":10494,"maximum":10494,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10494,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10494,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10494,"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":23203.86,"maximum":30937.88,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30937.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23203.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23203.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26806.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27075.03,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27611.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27343.1,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26806.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26806.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26806.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27477.14,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26806.96,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1431","type":"APR-DRG"}],"standard_charges":[{"minimum":3128,"maximum":3128,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3128,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3128,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3128,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1432","type":"APR-DRG"}],"standard_charges":[{"minimum":4547,"maximum":4547,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1433","type":"APR-DRG"}],"standard_charges":[{"minimum":6558,"maximum":6558,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6558,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6558,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6558,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1434","type":"APR-DRG"}],"standard_charges":[{"minimum":10193,"maximum":10193,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10193,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10193,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10193,"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":14857.89,"maximum":21250.54,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21250.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15938.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15938.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15006.47,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15303.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15155.05,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1441","type":"APR-DRG"}],"standard_charges":[{"minimum":3407,"maximum":3407,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3407,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3407,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3407,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1442","type":"APR-DRG"}],"standard_charges":[{"minimum":4339,"maximum":4339,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4339,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4339,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1443","type":"APR-DRG"}],"standard_charges":[{"minimum":6081,"maximum":6081,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6081,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6081,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1444","type":"APR-DRG"}],"standard_charges":[{"minimum":10382,"maximum":10382,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10382,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10382,"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":10435.38,"maximum":17568.04,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17568.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13176.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13176.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10435.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10539.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10748.45,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10644.09,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10435.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10435.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10435.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10696.27,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10435.38,"methodology":"case rate"}]}]},{"description":"ACUTE BRONCHITIS AND RELATED SYMPTOMS","code_information":[{"code":"1451","type":"APR-DRG"}],"standard_charges":[{"minimum":3119,"maximum":3119,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3119,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3119,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3119,"methodology":"case rate"}]}]},{"description":"ACUTE BRONCHITIS AND RELATED SYMPTOMS","code_information":[{"code":"1452","type":"APR-DRG"}],"standard_charges":[{"minimum":3735,"maximum":3735,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3735,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3735,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3735,"methodology":"case rate"}]}]},{"description":"ACUTE BRONCHITIS AND RELATED SYMPTOMS","code_information":[{"code":"1453","type":"APR-DRG"}],"standard_charges":[{"minimum":4971,"maximum":4971,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4971,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4971,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4971,"methodology":"case rate"}]}]},{"description":"ACUTE BRONCHITIS AND RELATED SYMPTOMS","code_information":[{"code":"1454","type":"APR-DRG"}],"standard_charges":[{"minimum":8526,"maximum":8526,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8526,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8526,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8526,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITH MCC","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"minimum":9840.68,"maximum":39787.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36228,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36228,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13120.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9840.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9840.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35052.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28905.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39787.02,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19013.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19203.76,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19584.03,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19393.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19013.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19013.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19013.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19488.97,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19013.62,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITH CC","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"minimum":10899.36,"maximum":25599.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23310,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23310,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17976.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13482.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13482.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22553.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18598.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25599.77,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10899.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11008.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11226.35,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11117.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10899.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10899.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10899.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11171.85,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10899.36,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"minimum":7465.13,"maximum":15687.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14284,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14284,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11286.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8464.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8464.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13820.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11396.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15687.05,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7465.13,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7539.79,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7689.09,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7614.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7465.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7465.13,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7465.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7651.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7465.13,"methodology":"case rate"}]}]},{"description":"DYSEQUILIBRIUM","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"minimum":7053.73,"maximum":16898.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13722,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13722,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11082.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8311.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8311.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14772.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10948.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16898.66,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7053.73,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7265.35,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7194.81,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7053.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7053.73,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7053.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7230.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7053.73,"methodology":"case rate"}]}]},{"description":"EPISTAXIS WITH MCC","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"minimum":6323.37,"maximum":26643.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24260,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24260,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8431,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6323.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6323.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23473.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19357,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26643.64,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11961.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12081.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12320.74,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12201.12,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11961.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11961.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11961.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12260.93,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11961.88,"methodology":"case rate"}]}]},{"description":"EPISTAXIS WITHOUT MCC","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"minimum":7134.93,"maximum":20838.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13132,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13132,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20838.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15629.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15629.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12706.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10478.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14422.43,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7206.28,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7348.98,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7277.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7313.31,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7134.93,"methodology":"case rate"}]}]},{"description":"OTITIS MEDIA AND URI WITH MCC","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"minimum":10048.73,"maximum":21434.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19517,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19517,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15920.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11940.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11940.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18883.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15572.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21434.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10048.73,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10149.22,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10350.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10249.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10048.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10048.73,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10048.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10299.95,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10048.73,"methodology":"case rate"}]}]},{"description":"OTITIS MEDIA AND URI WITHOUT MCC","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"minimum":6776.89,"maximum":14573.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13269,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13269,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13674.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10256.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10256.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12838.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10587.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14573.03,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6776.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6844.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6980.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6912.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6776.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6776.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6776.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6946.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6776.89,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITH MCC","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"minimum":13849.51,"maximum":29645.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26994,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26994,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24185.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18139.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18139.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26117.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21537.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29645.31,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13849.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13988.01,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14265,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14126.51,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13849.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13849.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13849.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14195.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13849.51,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITH CC","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"minimum":8492.85,"maximum":18589.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16927,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16927,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17571.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13178.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13178.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16377.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13505.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18589.69,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8492.85,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8577.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8747.64,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8662.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8492.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8492.85,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8492.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8705.18,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8492.85,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"minimum":6472.98,"maximum":14948.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12294,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12294,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14948.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11211.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11211.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11895.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9809.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13502.33,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6537.71,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6667.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6602.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6634.81,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH MCC","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"minimum":13936.12,"maximum":87916.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29359,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29359,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87916.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":65938.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":65938.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28405.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23424.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32242.62,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.12,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14075.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14354.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14214.85,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.12,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14284.53,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.12,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH CC","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":8546.98,"maximum":61027.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16279,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16279,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61027.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45771.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45771.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15750.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12988.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17877.95,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8546.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8632.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8803.39,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8717.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8546.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8546.98,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8546.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.66,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8546.98,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITHOUT CC/MCC","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"minimum":6374,"maximum":52392.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12640,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12640,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52392.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39295.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39295.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12229.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10085.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13881.92,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6374,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6437.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6565.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6501.48,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6374,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6374,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6374,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6533.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6374,"methodology":"case rate"}]}]},{"description":"MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY","code_information":[{"code":"1601","type":"APR-DRG"}],"standard_charges":[{"minimum":21347,"maximum":21347,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21347,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21347,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21347,"methodology":"case rate"}]}]},{"description":"MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY","code_information":[{"code":"1602","type":"APR-DRG"}],"standard_charges":[{"minimum":25166,"maximum":25166,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25166,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25166,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25166,"methodology":"case rate"}]}]},{"description":"MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY","code_information":[{"code":"1603","type":"APR-DRG"}],"standard_charges":[{"minimum":34134,"maximum":34134,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34134,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34134,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34134,"methodology":"case rate"}]}]},{"description":"MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY","code_information":[{"code":"1604","type":"APR-DRG"}],"standard_charges":[{"minimum":71957,"maximum":71957,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71957,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71957,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71957,"methodology":"case rate"}]}]},{"description":"IMPLANTABLE HEART ASSIST SYSTEMS","code_information":[{"code":"1611","type":"APR-DRG"}],"standard_charges":[{"minimum":74345,"maximum":74345,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74345,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74345,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74345,"methodology":"case rate"}]}]},{"description":"IMPLANTABLE HEART ASSIST SYSTEMS","code_information":[{"code":"1612","type":"APR-DRG"}],"standard_charges":[{"minimum":74345,"maximum":74345,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74345,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74345,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74345,"methodology":"case rate"}]}]},{"description":"IMPLANTABLE HEART ASSIST SYSTEMS","code_information":[{"code":"1613","type":"APR-DRG"}],"standard_charges":[{"minimum":106148,"maximum":106148,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106148,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106148,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106148,"methodology":"case rate"}]}]},{"description":"IMPLANTABLE HEART ASSIST SYSTEMS","code_information":[{"code":"1614","type":"APR-DRG"}],"standard_charges":[{"minimum":152253,"maximum":152253,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152253,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152253,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152253,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1621","type":"APR-DRG"}],"standard_charges":[{"minimum":26259,"maximum":26259,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26259,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26259,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26259,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1622","type":"APR-DRG"}],"standard_charges":[{"minimum":30345,"maximum":30345,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30345,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30345,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30345,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1623","type":"APR-DRG"}],"standard_charges":[{"minimum":40718,"maximum":40718,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40718,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40718,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40718,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1624","type":"APR-DRG"}],"standard_charges":[{"minimum":62781,"maximum":62781,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62781,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62781,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62781,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST PROCEDURES WITH MCC","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"minimum":36916.33,"maximum":100544.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91552,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91552,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73134.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54851.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54851.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":88579.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":73047.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":100544.43,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":36916.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":37285.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38023.82,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":37654.66,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":36916.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":36916.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":36916.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":37839.24,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":36916.33,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1631","type":"APR-DRG"}],"standard_charges":[{"minimum":22567,"maximum":22567,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22567,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22567,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22567,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1632","type":"APR-DRG"}],"standard_charges":[{"minimum":24948,"maximum":24948,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24948,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24948,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24948,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1633","type":"APR-DRG"}],"standard_charges":[{"minimum":33261,"maximum":33261,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33261,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33261,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33261,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1634","type":"APR-DRG"}],"standard_charges":[{"minimum":52225,"maximum":52225,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52225,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52225,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52225,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST PROCEDURES WITH CC","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"minimum":20737.31,"maximum":54053.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47556,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47556,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54053.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40541.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40541.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":46011.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37943.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52226.9,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20737.31,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20944.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21359.43,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21152.06,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20737.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20737.31,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20737.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21255.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20737.31,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"minimum":15687.65,"maximum":40690.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34737,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34737,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40690.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30518.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30518.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33609.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27715.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38148.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15687.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15844.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16158.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16001.41,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15687.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15687.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15687.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16079.85,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15687.65,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1651","type":"APR-DRG"}],"standard_charges":[{"minimum":21953,"maximum":21953,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21953,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21953,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21953,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1652","type":"APR-DRG"}],"standard_charges":[{"minimum":25927,"maximum":25927,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25927,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25927,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25927,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1653","type":"APR-DRG"}],"standard_charges":[{"minimum":32900,"maximum":32900,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32900,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32900,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32900,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1654","type":"APR-DRG"}],"standard_charges":[{"minimum":48199,"maximum":48199,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48199,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48199,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48199,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"minimum":31047.74,"maximum":76964.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70081,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70081,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59300.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44476.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44476.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":67805.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":55915.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":76964.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31047.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31358.22,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31979.18,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31668.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31047.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31047.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31047.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31823.94,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31047.74,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1661","type":"APR-DRG"}],"standard_charges":[{"minimum":19293,"maximum":19293,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19293,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19293,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19293,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1662","type":"APR-DRG"}],"standard_charges":[{"minimum":21531,"maximum":21531,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21531,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21531,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21531,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1663","type":"APR-DRG"}],"standard_charges":[{"minimum":26996,"maximum":26996,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26996,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26996,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26996,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1664","type":"APR-DRG"}],"standard_charges":[{"minimum":41537,"maximum":41537,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41537,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41537,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41537,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"minimum":15403.07,"maximum":39494.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35962,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35962,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29363.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22022.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22022.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34794.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28693.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39494.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15403.07,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15557.11,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15865.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15711.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15403.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15403.07,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15403.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15788.15,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15403.07,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES","code_information":[{"code":"1671","type":"APR-DRG"}],"standard_charges":[{"minimum":18628,"maximum":18628,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18628,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18628,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18628,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES","code_information":[{"code":"1672","type":"APR-DRG"}],"standard_charges":[{"minimum":18628,"maximum":18628,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18628,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18628,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18628,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES","code_information":[{"code":"1673","type":"APR-DRG"}],"standard_charges":[{"minimum":28997,"maximum":28997,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28997,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28997,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28997,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES","code_information":[{"code":"1674","type":"APR-DRG"}],"standard_charges":[{"minimum":50543,"maximum":50543,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50543,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50543,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50543,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"minimum":11743.03,"maximum":27369.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24922,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24922,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22763,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17072.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17072.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24112.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19884.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27369.82,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11743.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11860.47,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12095.33,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11977.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11743.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11743.03,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11743.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12036.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11743.03,"methodology":"case rate"}]}]},{"description":"MAJOR ABDOMINAL VASCULAR PROCEDURES","code_information":[{"code":"1691","type":"APR-DRG"}],"standard_charges":[{"minimum":16259,"maximum":16259,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16259,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16259,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16259,"methodology":"case rate"}]}]},{"description":"MAJOR ABDOMINAL VASCULAR PROCEDURES","code_information":[{"code":"1692","type":"APR-DRG"}],"standard_charges":[{"minimum":17171,"maximum":17171,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17171,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17171,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17171,"methodology":"case rate"}]}]},{"description":"MAJOR ABDOMINAL VASCULAR PROCEDURES","code_information":[{"code":"1693","type":"APR-DRG"}],"standard_charges":[{"minimum":23881,"maximum":23881,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23881,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23881,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23881,"methodology":"case rate"}]}]},{"description":"MAJOR ABDOMINAL VASCULAR PROCEDURES","code_information":[{"code":"1694","type":"APR-DRG"}],"standard_charges":[{"minimum":40640,"maximum":40640,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40640,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40640,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40640,"methodology":"case rate"}]}]},{"description":"NURSERY LEVEL I","code_information":[{"code":"170","type":"RC"}],"standard_charges":[{"minimum":741,"maximum":1013,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":882,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":741,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1013,"methodology":"per diem"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1701","type":"APR-DRG"}],"standard_charges":[{"minimum":12650,"maximum":12650,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12650,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12650,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12650,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1702","type":"APR-DRG"}],"standard_charges":[{"minimum":14918,"maximum":14918,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14918,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14918,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14918,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1703","type":"APR-DRG"}],"standard_charges":[{"minimum":17435,"maximum":17435,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17435,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17435,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17435,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1704","type":"APR-DRG"}],"standard_charges":[{"minimum":28735,"maximum":28735,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28735,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28735,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28735,"methodology":"case rate"}]}]},{"description":"NURSERY LEVEL I","code_information":[{"code":"171","type":"RC"}],"standard_charges":[{"minimum":741,"maximum":1013,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":882,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":741,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1013,"methodology":"per diem"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1711","type":"APR-DRG"}],"standard_charges":[{"minimum":9520,"maximum":9520,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9520,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9520,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9520,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1712","type":"APR-DRG"}],"standard_charges":[{"minimum":10886,"maximum":10886,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10886,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10886,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10886,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1713","type":"APR-DRG"}],"standard_charges":[{"minimum":14323,"maximum":14323,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14323,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14323,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14323,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1714","type":"APR-DRG"}],"standard_charges":[{"minimum":23006,"maximum":23006,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23006,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23006,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23006,"methodology":"case rate"}]}]},{"description":"NURSERY LEVEL II","code_information":[{"code":"172","type":"RC"}],"standard_charges":[{"minimum":7340,"maximum":9994,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":8755,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7340,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9994,"methodology":"per diem"}]}]},{"description":"NURSERY LEVEL III","code_information":[{"code":"173","type":"RC"}],"standard_charges":[{"minimum":7340,"maximum":9994,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":8755,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7340,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9994,"methodology":"per diem"}]}]},{"description":"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"minimum":25002.84,"maximum":40151.06,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40151.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30113.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30113.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25002.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25252.87,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25752.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25502.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25002.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25002.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25002.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25627.92,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25002.84,"methodology":"case rate"}]}]},{"description":"NURSERY LEVEL IV","code_information":[{"code":"174","type":"RC"}],"standard_charges":[{"minimum":7340,"maximum":9994,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":8755,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7340,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9994,"methodology":"per diem"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITH AMI","code_information":[{"code":"1741","type":"APR-DRG"}],"standard_charges":[{"minimum":11457,"maximum":11457,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11457,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11457,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11457,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITH AMI","code_information":[{"code":"1742","type":"APR-DRG"}],"standard_charges":[{"minimum":12693,"maximum":12693,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12693,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12693,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12693,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITH AMI","code_information":[{"code":"1743","type":"APR-DRG"}],"standard_charges":[{"minimum":16428,"maximum":16428,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16428,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16428,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16428,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITH AMI","code_information":[{"code":"1744","type":"APR-DRG"}],"standard_charges":[{"minimum":24121,"maximum":24121,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24121,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24121,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24121,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":12169.9,"maximum":31893.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27133,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27133,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31893.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23920.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23920.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26251.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21648.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29797.97,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12169.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12291.6,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12535,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12413.3,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12169.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12169.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12169.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12474.15,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12169.9,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI","code_information":[{"code":"1751","type":"APR-DRG"}],"standard_charges":[{"minimum":12590,"maximum":12590,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12590,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12590,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12590,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI","code_information":[{"code":"1752","type":"APR-DRG"}],"standard_charges":[{"minimum":14246,"maximum":14246,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14246,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14246,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14246,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI","code_information":[{"code":"1753","type":"APR-DRG"}],"standard_charges":[{"minimum":17501,"maximum":17501,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17501,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17501,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17501,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI","code_information":[{"code":"1754","type":"APR-DRG"}],"standard_charges":[{"minimum":26742,"maximum":26742,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26742,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26742,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26742,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM WITHOUT MCC","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":7571.84,"maximum":26002.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15937,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15937,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26002.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19502.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19502.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15419.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12715.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17502.49,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7571.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7647.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7799,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7723.28,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7571.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7571.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7571.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7761.14,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7571.84,"methodology":"case rate"}]}]},{"description":"INSERTION REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES","code_information":[{"code":"1761","type":"APR-DRG"}],"standard_charges":[{"minimum":10772,"maximum":10772,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10772,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10772,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10772,"methodology":"case rate"}]}]},{"description":"INSERTION REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES","code_information":[{"code":"1762","type":"APR-DRG"}],"standard_charges":[{"minimum":13207,"maximum":13207,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13207,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13207,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13207,"methodology":"case rate"}]}]},{"description":"INSERTION REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES","code_information":[{"code":"1763","type":"APR-DRG"}],"standard_charges":[{"minimum":20352,"maximum":20352,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20352,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20352,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20352,"methodology":"case rate"}]}]},{"description":"INSERTION REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES","code_information":[{"code":"1764","type":"APR-DRG"}],"standard_charges":[{"minimum":34846,"maximum":34846,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34846,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34846,"methodology":"case rate"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":13773.72,"maximum":39109.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35526,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35526,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39109.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29332.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29332.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34372.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28345.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39015.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13773.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13911.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14186.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14049.2,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13773.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13773.72,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13773.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14118.07,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13773.72,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT","code_information":[{"code":"1771","type":"APR-DRG"}],"standard_charges":[{"minimum":8026,"maximum":8026,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8026,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8026,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8026,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT","code_information":[{"code":"1772","type":"APR-DRG"}],"standard_charges":[{"minimum":11763,"maximum":11763,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11763,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11763,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11763,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT","code_information":[{"code":"1773","type":"APR-DRG"}],"standard_charges":[{"minimum":16095,"maximum":16095,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16095,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16095,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT","code_information":[{"code":"1774","type":"APR-DRG"}],"standard_charges":[{"minimum":21915,"maximum":21915,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21915,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21915,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21915,"methodology":"case rate"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":8945.23,"maximum":33014.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23355,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23355,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33014.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24761.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24761.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22596.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18634.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25649.27,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8945.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9034.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9213.59,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9124.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8945.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8945.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8945.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9168.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8945.23,"methodology":"case rate"}]}]},{"description":"EXTERNAL HEART ASSIST SYSTEMS","code_information":[{"code":"1781","type":"APR-DRG"}],"standard_charges":[{"minimum":28019,"maximum":28019,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28019,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28019,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28019,"methodology":"case rate"}]}]},{"description":"EXTERNAL HEART ASSIST SYSTEMS","code_information":[{"code":"1782","type":"APR-DRG"}],"standard_charges":[{"minimum":31517,"maximum":31517,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31517,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31517,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31517,"methodology":"case rate"}]}]},{"description":"EXTERNAL HEART ASSIST SYSTEMS","code_information":[{"code":"1783","type":"APR-DRG"}],"standard_charges":[{"minimum":36996,"maximum":36996,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36996,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36996,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36996,"methodology":"case rate"}]}]},{"description":"EXTERNAL HEART ASSIST SYSTEMS","code_information":[{"code":"1784","type":"APR-DRG"}],"standard_charges":[{"minimum":52750,"maximum":52750,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52750,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52750,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52750,"methodology":"case rate"}]}]},{"description":"NURSERY LEVEL I","code_information":[{"code":"179","type":"RC"}],"standard_charges":[{"minimum":741,"maximum":1013,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":882,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":741,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1013,"methodology":"per diem"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"minimum":7225.4,"maximum":28809.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16269,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16269,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28809.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21607.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21607.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15741.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12981.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17867.64,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7225.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7297.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7442.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7369.91,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7225.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7225.4,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7225.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7406.04,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7225.4,"methodology":"case rate"}]}]},{"description":"DEFIBRILLATOR IMPLANTS","code_information":[{"code":"1791","type":"APR-DRG"}],"standard_charges":[{"minimum":22153,"maximum":22153,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22153,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22153,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22153,"methodology":"case rate"}]}]},{"description":"DEFIBRILLATOR IMPLANTS","code_information":[{"code":"1792","type":"APR-DRG"}],"standard_charges":[{"minimum":25100,"maximum":25100,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25100,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25100,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25100,"methodology":"case rate"}]}]},{"description":"DEFIBRILLATOR IMPLANTS","code_information":[{"code":"1793","type":"APR-DRG"}],"standard_charges":[{"minimum":30528,"maximum":30528,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30528,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30528,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30528,"methodology":"case rate"}]}]},{"description":"DEFIBRILLATOR IMPLANTS","code_information":[{"code":"1794","type":"APR-DRG"}],"standard_charges":[{"minimum":41327,"maximum":41327,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41327,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41327,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41327,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITH MCC","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":14789.07,"maximum":35584.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32402,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32402,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28715.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21537.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21537.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31350.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25852.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35584.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14789.07,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14936.97,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15232.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15084.86,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14789.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14789.07,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14789.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15158.8,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14789.07,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM PROCEDURES","code_information":[{"code":"1801","type":"APR-DRG"}],"standard_charges":[{"minimum":7462,"maximum":7462,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7462,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7462,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7462,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM PROCEDURES","code_information":[{"code":"1802","type":"APR-DRG"}],"standard_charges":[{"minimum":9888,"maximum":9888,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9888,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9888,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9888,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM PROCEDURES","code_information":[{"code":"1803","type":"APR-DRG"}],"standard_charges":[{"minimum":14161,"maximum":14161,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14161,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14161,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14161,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM PROCEDURES","code_information":[{"code":"1804","type":"APR-DRG"}],"standard_charges":[{"minimum":26540,"maximum":26540,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26540,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26540,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26540,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITH CC","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"minimum":9859.27,"maximum":23765.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21640,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21640,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21793.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16345.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16345.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20937.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17266.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23765.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9859.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9957.87,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10155.05,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10056.46,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9859.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9859.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9859.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10105.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9859.27,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY ARTERIAL PROCEDURES","code_information":[{"code":"1811","type":"APR-DRG"}],"standard_charges":[{"minimum":8921,"maximum":8921,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8921,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8921,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY ARTERIAL PROCEDURES","code_information":[{"code":"1812","type":"APR-DRG"}],"standard_charges":[{"minimum":12942,"maximum":12942,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12942,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12942,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12942,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY ARTERIAL PROCEDURES","code_information":[{"code":"1813","type":"APR-DRG"}],"standard_charges":[{"minimum":20971,"maximum":20971,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20971,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20971,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20971,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY ARTERIAL PROCEDURES","code_information":[{"code":"1814","type":"APR-DRG"}],"standard_charges":[{"minimum":35404,"maximum":35404,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35404,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35404,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35404,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITHOUT CC/MCC","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"minimum":7749.7,"maximum":17386.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15831,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15831,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16547.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12410.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12410.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15317.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12631.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17386.96,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7749.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7827.2,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7982.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7904.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7749.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7749.7,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7749.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7943.45,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7749.7,"methodology":"case rate"}]}]},{"description":"OTHER PERIPHERAL VASCULAR PROCEDURES","code_information":[{"code":"1821","type":"APR-DRG"}],"standard_charges":[{"minimum":12195,"maximum":12195,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12195,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12195,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12195,"methodology":"case rate"}]}]},{"description":"OTHER PERIPHERAL VASCULAR PROCEDURES","code_information":[{"code":"1822","type":"APR-DRG"}],"standard_charges":[{"minimum":13671,"maximum":13671,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13671,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13671,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13671,"methodology":"case rate"}]}]},{"description":"OTHER PERIPHERAL VASCULAR PROCEDURES","code_information":[{"code":"1823","type":"APR-DRG"}],"standard_charges":[{"minimum":16703,"maximum":16703,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16703,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16703,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16703,"methodology":"case rate"}]}]},{"description":"OTHER PERIPHERAL VASCULAR PROCEDURES","code_information":[{"code":"1824","type":"APR-DRG"}],"standard_charges":[{"minimum":29883,"maximum":29883,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29883,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29883,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29883,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITH MCC","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"minimum":13547.92,"maximum":31134.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28350,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28350,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29460.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22095.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22095.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27429.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22619.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31134.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13547.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13683.4,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13954.36,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13818.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13547.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13547.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13547.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13886.62,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13547.92,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES","code_information":[{"code":"1831","type":"APR-DRG"}],"standard_charges":[{"minimum":25564,"maximum":25564,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25564,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25564,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25564,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES","code_information":[{"code":"1832","type":"APR-DRG"}],"standard_charges":[{"minimum":26889,"maximum":26889,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26889,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26889,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26889,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES","code_information":[{"code":"1833","type":"APR-DRG"}],"standard_charges":[{"minimum":31974,"maximum":31974,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31974,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31974,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31974,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES","code_information":[{"code":"1834","type":"APR-DRG"}],"standard_charges":[{"minimum":46493,"maximum":46493,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46493,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46493,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46493,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITH CC","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":9532.94,"maximum":24202.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19126,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19126,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24202.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18152.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18152.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18505.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15260.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21005.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9532.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9628.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9818.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9723.6,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9532.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9532.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9532.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9771.27,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9532.94,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITHOUT CC/MCC","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"minimum":7287.27,"maximum":19741.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13788,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19741.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14806.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14806.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13340.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11001.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15142.42,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7287.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7360.15,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7505.89,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7433.02,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7287.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7287.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7287.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7469.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7287.27,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITH MCC","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"minimum":13491.47,"maximum":31830.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28983,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28983,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29273.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21955.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21955.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28042.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23124.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31830.02,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13491.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13626.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13896.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13761.3,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13491.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13491.47,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13491.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13828.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13491.47,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITH CC","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"minimum":9037.25,"maximum":23375.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19309,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19309,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23375.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17532.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17532.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18682.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15406.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21205.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9037.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9127.63,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.37,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9218,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9037.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9037.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9037.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9263.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9037.25,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITHOUT CC/MCC","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"minimum":6950.88,"maximum":19738.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13729,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13729,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19738.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14803.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14803.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13284.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10954.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15078.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7159.41,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7124.66,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6950.88,"methodology":"case rate"}]}]},{"description":"PULMONARY EDEMA AND RESPIRATORY FAILURE","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":10842.14,"maximum":25079.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22836,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22836,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17093.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12820.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12820.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22095.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18220.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25079.89,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10842.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10950.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11167.41,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11058.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10842.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10842.14,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10842.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11113.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10842.14,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":9957.48,"maximum":23600.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21490,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21490,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23019.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17264.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17264.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20792.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17146.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23600.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9957.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10057.06,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10256.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10156.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9957.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9957.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9957.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10206.42,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9957.48,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION","code_information":[{"code":"1901","type":"APR-DRG"}],"standard_charges":[{"minimum":4848,"maximum":4848,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4848,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4848,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4848,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION","code_information":[{"code":"1902","type":"APR-DRG"}],"standard_charges":[{"minimum":5467,"maximum":5467,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5467,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5467,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5467,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION","code_information":[{"code":"1903","type":"APR-DRG"}],"standard_charges":[{"minimum":7270,"maximum":7270,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7270,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7270,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION","code_information":[{"code":"1904","type":"APR-DRG"}],"standard_charges":[{"minimum":11348,"maximum":11348,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11348,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11348,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11348,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":7916.74,"maximum":18418.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16771,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16771,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17523.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13142.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13142.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16226.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13381.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18418.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7995.91,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8154.25,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8075.08,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8114.66,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.74,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE","code_information":[{"code":"1911","type":"APR-DRG"}],"standard_charges":[{"minimum":5789,"maximum":5789,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5789,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5789,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5789,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE","code_information":[{"code":"1912","type":"APR-DRG"}],"standard_charges":[{"minimum":6790,"maximum":6790,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6790,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6790,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6790,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE","code_information":[{"code":"1913","type":"APR-DRG"}],"standard_charges":[{"minimum":9052,"maximum":9052,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9052,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9052,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9052,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE","code_information":[{"code":"1914","type":"APR-DRG"}],"standard_charges":[{"minimum":14273,"maximum":14273,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14273,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14273,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14273,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"minimum":6278.11,"maximum":14688.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13322,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13322,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14688.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11016.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11016.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12889.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10629.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14630.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.11,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6340.9,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6466.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6403.68,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.11,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6435.07,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.11,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS","code_information":[{"code":"1921","type":"APR-DRG"}],"standard_charges":[{"minimum":6173,"maximum":6173,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6173,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6173,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6173,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS","code_information":[{"code":"1922","type":"APR-DRG"}],"standard_charges":[{"minimum":7744,"maximum":7744,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7744,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7744,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7744,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS","code_information":[{"code":"1923","type":"APR-DRG"}],"standard_charges":[{"minimum":11287,"maximum":11287,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11287,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11287,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11287,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS","code_information":[{"code":"1924","type":"APR-DRG"}],"standard_charges":[{"minimum":18291,"maximum":18291,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18291,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18291,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18291,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITH MCC","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":11463.1,"maximum":27510.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25049,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25049,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24486.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18365.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18365.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24236.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19986.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27510.1,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11463.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11577.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11807,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11692.37,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11463.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11463.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11463.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11749.68,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11463.1,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS","code_information":[{"code":"1931","type":"APR-DRG"}],"standard_charges":[{"minimum":5283,"maximum":5283,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5283,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5283,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5283,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS","code_information":[{"code":"1932","type":"APR-DRG"}],"standard_charges":[{"minimum":7094,"maximum":7094,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7094,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7094,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7094,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS","code_information":[{"code":"1933","type":"APR-DRG"}],"standard_charges":[{"minimum":10930,"maximum":10930,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10930,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10930,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10930,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS","code_information":[{"code":"1934","type":"APR-DRG"}],"standard_charges":[{"minimum":15695,"maximum":15695,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15695,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15695,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15695,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITH CC","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":7614.38,"maximum":20357.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16692,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16692,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20357.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15268.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15268.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16150.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13318.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18331.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7614.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7690.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7842.82,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7614.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7614.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7614.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.74,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7614.38,"methodology":"case rate"}]}]},{"description":"HEART FAILURE","code_information":[{"code":"1941","type":"APR-DRG"}],"standard_charges":[{"minimum":3167,"maximum":3167,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3167,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3167,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3167,"methodology":"case rate"}]}]},{"description":"HEART FAILURE","code_information":[{"code":"1942","type":"APR-DRG"}],"standard_charges":[{"minimum":4282,"maximum":4282,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4282,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4282,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4282,"methodology":"case rate"}]}]},{"description":"HEART FAILURE","code_information":[{"code":"1943","type":"APR-DRG"}],"standard_charges":[{"minimum":6045,"maximum":6045,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6045,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6045,"methodology":"case rate"}]}]},{"description":"HEART FAILURE","code_information":[{"code":"1944","type":"APR-DRG"}],"standard_charges":[{"minimum":9898,"maximum":9898,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9898,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9898,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9898,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":6088.65,"maximum":17152.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12813,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12813,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17152.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12864.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12864.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12397.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10223.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14071.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6088.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6149.54,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6271.31,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6210.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6088.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6088.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6088.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6240.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6088.65,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH MCC","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"minimum":15843.08,"maximum":34563.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31472,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31472,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31927.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23946.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23946.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30450.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25110.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34563.5,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15843.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16001.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16318.38,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16159.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15843.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15843.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15843.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16239.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15843.08,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST AND SHOCK","code_information":[{"code":"1961","type":"APR-DRG"}],"standard_charges":[{"minimum":2733,"maximum":2733,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2733,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2733,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2733,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST AND SHOCK","code_information":[{"code":"1962","type":"APR-DRG"}],"standard_charges":[{"minimum":3747,"maximum":3747,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3747,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3747,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3747,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST AND SHOCK","code_information":[{"code":"1963","type":"APR-DRG"}],"standard_charges":[{"minimum":5382,"maximum":5382,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5382,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5382,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST AND SHOCK","code_information":[{"code":"1964","type":"APR-DRG"}],"standard_charges":[{"minimum":10975,"maximum":10975,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10975,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10975,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10975,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH CC","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"minimum":8928.99,"maximum":23358.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19188,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19188,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23358.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17519.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17519.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18565.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15310.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21073.54,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8928.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9018.28,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9196.86,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9107.57,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8928.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8928.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8928.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9152.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8928.99,"methodology":"case rate"}]}]},{"description":"PERIPHERAL AND OTHER VASCULAR DISORDERS","code_information":[{"code":"1971","type":"APR-DRG"}],"standard_charges":[{"minimum":3393,"maximum":3393,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3393,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3393,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3393,"methodology":"case rate"}]}]},{"description":"PERIPHERAL AND OTHER VASCULAR DISORDERS","code_information":[{"code":"1972","type":"APR-DRG"}],"standard_charges":[{"minimum":4406,"maximum":4406,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4406,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4406,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4406,"methodology":"case rate"}]}]},{"description":"PERIPHERAL AND OTHER VASCULAR DISORDERS","code_information":[{"code":"1973","type":"APR-DRG"}],"standard_charges":[{"minimum":6115,"maximum":6115,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6115,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6115,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6115,"methodology":"case rate"}]}]},{"description":"PERIPHERAL AND OTHER VASCULAR DISORDERS","code_information":[{"code":"1974","type":"APR-DRG"}],"standard_charges":[{"minimum":12757,"maximum":12757,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12757,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12757,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12757,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"minimum":6689.51,"maximum":18654.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14182,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14182,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18654.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13991.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13991.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13722.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11315.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15575.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6689.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6756.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6890.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6823.31,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6689.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6689.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6689.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6856.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6689.51,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS","code_information":[{"code":"1981","type":"APR-DRG"}],"standard_charges":[{"minimum":3312,"maximum":3312,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3312,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3312,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3312,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS","code_information":[{"code":"1982","type":"APR-DRG"}],"standard_charges":[{"minimum":3860,"maximum":3860,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3860,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3860,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3860,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS","code_information":[{"code":"1983","type":"APR-DRG"}],"standard_charges":[{"minimum":5153,"maximum":5153,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5153,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5153,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5153,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS","code_information":[{"code":"1984","type":"APR-DRG"}],"standard_charges":[{"minimum":9996,"maximum":9996,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9996,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9996,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9996,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITH MCC","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":9591.48,"maximum":37012.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33702,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33702,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12788.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9591.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9591.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32607.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26889.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37012.28,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14924.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15073.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15372.14,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15222.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14924.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14924.4,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14924.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15297.51,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14924.4,"methodology":"case rate"}]}]},{"description":"HYPERTENSION","code_information":[{"code":"1991","type":"APR-DRG"}],"standard_charges":[{"minimum":3303,"maximum":3303,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3303,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3303,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3303,"methodology":"case rate"}]}]},{"description":"HYPERTENSION","code_information":[{"code":"1992","type":"APR-DRG"}],"standard_charges":[{"minimum":3880,"maximum":3880,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3880,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3880,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3880,"methodology":"case rate"}]}]},{"description":"HYPERTENSION","code_information":[{"code":"1993","type":"APR-DRG"}],"standard_charges":[{"minimum":5422,"maximum":5422,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5422,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5422,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5422,"methodology":"case rate"}]}]},{"description":"HYPERTENSION","code_information":[{"code":"1994","type":"APR-DRG"}],"standard_charges":[{"minimum":8747,"maximum":8747,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITH CC","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"minimum":7535.61,"maximum":22323.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20327,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20327,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10047.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7535.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7535.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19667.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16218.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22323.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9837.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9936,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10132.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10034.38,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9837.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9837.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9837.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10083.57,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9837.62,"methodology":"case rate"}]}]},{"description":"CARDIAC STRUCTURAL AND VALVULAR DISORDERS","code_information":[{"code":"2001","type":"APR-DRG"}],"standard_charges":[{"minimum":3550,"maximum":3550,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3550,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3550,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3550,"methodology":"case rate"}]}]},{"description":"ROOM ICU GENERAL","code_information":[{"code":"2001000921","type":"CDM"},{"code":"0200","type":"RC"}],"standard_charges":[{"minimum":2588.2,"maximum":5579.3,"gross_charge":6829,"discounted_cash":1563.85,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2588.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2588.2,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3619.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5579.3,"methodology":"fee schedule"}]}]},{"description":"CARDIAC STRUCTURAL AND VALVULAR DISORDERS","code_information":[{"code":"2002","type":"APR-DRG"}],"standard_charges":[{"minimum":4493,"maximum":4493,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4493,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4493,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4493,"methodology":"case rate"}]}]},{"description":"CARDIAC STRUCTURAL AND VALVULAR DISORDERS","code_information":[{"code":"2003","type":"APR-DRG"}],"standard_charges":[{"minimum":6402,"maximum":6402,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6402,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6402,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6402,"methodology":"case rate"}]}]},{"description":"CARDIAC STRUCTURAL AND VALVULAR DISORDERS","code_information":[{"code":"2004","type":"APR-DRG"}],"standard_charges":[{"minimum":11805,"maximum":11805,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11805,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11805,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11805,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITHOUT CC/MCC","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"minimum":6509.33,"maximum":14812.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13487,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13487,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14314.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10736.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10736.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13049.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10761.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14812.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6509.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6574.43,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6704.61,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6639.52,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6509.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6509.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6509.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6672.07,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6509.33,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS","code_information":[{"code":"2011","type":"APR-DRG"}],"standard_charges":[{"minimum":2795,"maximum":2795,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2795,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2795,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2795,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS","code_information":[{"code":"2012","type":"APR-DRG"}],"standard_charges":[{"minimum":3674,"maximum":3674,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3674,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3674,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3674,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS","code_information":[{"code":"2013","type":"APR-DRG"}],"standard_charges":[{"minimum":5514,"maximum":5514,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5514,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5514,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5514,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS","code_information":[{"code":"2014","type":"APR-DRG"}],"standard_charges":[{"minimum":9930,"maximum":9930,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9930,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9930,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9930,"methodology":"case rate"}]}]},{"description":"BRONCHITIS AND ASTHMA WITH CC/MCC","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"minimum":8748.81,"maximum":23226.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17808,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17808,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23226.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17420.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17420.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17229.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14208.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19557.24,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8748.81,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8836.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9011.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8923.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8748.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8748.81,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8748.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8967.54,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8748.81,"methodology":"case rate"}]}]},{"description":"BRONCHITIS AND ASTHMA WITHOUT CC/MCC","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"minimum":6660.12,"maximum":17138.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13033,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13033,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17138.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12854.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12854.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12609.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10398.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14313.09,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6660.12,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6726.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6859.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6793.33,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6660.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6660.12,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6660.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6826.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6660.12,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"2031","type":"APR-DRG"}],"standard_charges":[{"minimum":3437,"maximum":3437,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3437,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3437,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3437,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"2032","type":"APR-DRG"}],"standard_charges":[{"minimum":3905,"maximum":3905,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3905,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3905,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3905,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"2033","type":"APR-DRG"}],"standard_charges":[{"minimum":4846,"maximum":4846,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4846,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4846,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"2034","type":"APR-DRG"}],"standard_charges":[{"minimum":6804,"maximum":6804,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6804,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6804,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6804,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS AND SYMPTOMS","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"minimum":7544.78,"maximum":133300.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15262,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15262,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133300.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":99977.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":99977.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14767.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12177.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16761.87,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7544.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7620.23,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7771.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7695.68,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7544.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7544.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7544.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7733.4,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7544.78,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"2041","type":"APR-DRG"}],"standard_charges":[{"minimum":3761,"maximum":3761,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3761,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3761,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3761,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"2042","type":"APR-DRG"}],"standard_charges":[{"minimum":4220,"maximum":4220,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"2043","type":"APR-DRG"}],"standard_charges":[{"minimum":5348,"maximum":5348,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5348,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5348,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5348,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"2044","type":"APR-DRG"}],"standard_charges":[{"minimum":8623,"maximum":8623,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8623,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8623,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8623,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"minimum":15871.69,"maximum":49828.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49828.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37371.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37371.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29701.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24493.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33713.54,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15871.69,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16030.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16347.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16189.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15871.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15871.69,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15871.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16268.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15871.69,"methodology":"case rate"}]}]},{"description":"CARDIOMYOPATHY","code_information":[{"code":"2051","type":"APR-DRG"}],"standard_charges":[{"minimum":3435,"maximum":3435,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3435,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3435,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3435,"methodology":"case rate"}]}]},{"description":"CARDIOMYOPATHY","code_information":[{"code":"2052","type":"APR-DRG"}],"standard_charges":[{"minimum":4332,"maximum":4332,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4332,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4332,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4332,"methodology":"case rate"}]}]},{"description":"CARDIOMYOPATHY","code_information":[{"code":"2053","type":"APR-DRG"}],"standard_charges":[{"minimum":6357,"maximum":6357,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6357,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6357,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6357,"methodology":"case rate"}]}]},{"description":"CARDIOMYOPATHY","code_information":[{"code":"2054","type":"APR-DRG"}],"standard_charges":[{"minimum":12582,"maximum":12582,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12582,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12582,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"minimum":8277.87,"maximum":182951.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16389,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16389,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182951.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":137216.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":137216.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15857.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13077.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17999.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8277.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8360.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8526.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8443.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8277.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8277.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8277.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8484.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8277.87,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE","code_information":[{"code":"2061","type":"APR-DRG"}],"standard_charges":[{"minimum":4767,"maximum":4767,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4767,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4767,"methodology":"case rate"}]}]},{"description":"ROOM INTER ICU/TELE","code_information":[{"code":"2061000922","type":"CDM"},{"code":"0206","type":"RC"}],"standard_charges":[{"minimum":1765.77,"maximum":3806.41,"gross_charge":4659,"discounted_cash":1066.92,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1765.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1765.77,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3806.41,"methodology":"fee schedule"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE","code_information":[{"code":"2062","type":"APR-DRG"}],"standard_charges":[{"minimum":4911,"maximum":4911,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4911,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4911,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4911,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE","code_information":[{"code":"2063","type":"APR-DRG"}],"standard_charges":[{"minimum":7157,"maximum":7157,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7157,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7157,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7157,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE","code_information":[{"code":"2064","type":"APR-DRG"}],"standard_charges":[{"minimum":15363,"maximum":15363,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15363,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15363,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15363,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":51284.28,"maximum":144829.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107743,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107743,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144829.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":108623.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":108623.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":104244.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":85965.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":118325.42,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":51284.28,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":51797.13,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":52822.81,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":52309.97,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":51284.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":51284.28,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":51284.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":52566.39,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":51284.28,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES","code_information":[{"code":"2071","type":"APR-DRG"}],"standard_charges":[{"minimum":3409,"maximum":3409,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3409,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3409,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3409,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES","code_information":[{"code":"2072","type":"APR-DRG"}],"standard_charges":[{"minimum":4339,"maximum":4339,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4339,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4339,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES","code_information":[{"code":"2073","type":"APR-DRG"}],"standard_charges":[{"minimum":6272,"maximum":6272,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6272,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6272,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6272,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES","code_information":[{"code":"2074","type":"APR-DRG"}],"standard_charges":[{"minimum":11019,"maximum":11019,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11019,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11019,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11019,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":22027.18,"maximum":73286.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46663,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46663,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73286.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54966.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54966.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45148.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37231.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51246.98,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22027.18,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22247.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22688,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22467.73,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22027.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22027.18,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22027.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22577.86,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22027.18,"methodology":"case rate"}]}]},{"description":"CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"minimum":85516.04,"maximum":297843.28,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297843.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":223386.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":223386.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":85516.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":86371.21,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":88081.53,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":87226.37,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":85516.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":85516.04,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":85516.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":87653.95,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":85516.04,"methodology":"case rate"}]}]},{"description":"OTHER HEART ASSIST SYSTEM IMPLANT","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"minimum":83203.09,"maximum":265840.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242065,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":242065,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195390.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":146545.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":146545.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":234204.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":193136.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":265840.24,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":83203.09,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":84035.13,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":85699.19,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":84867.16,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":83203.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":83203.09,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":83203.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":85283.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":83203.09,"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":75905.44,"maximum":207174.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188646,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188646,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159209.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":119409.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":119409.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":182520.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":150515.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":207174.71,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":75905.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":76664.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":78182.61,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":77423.55,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":75905.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":75905.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":75905.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":77803.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":75905.44,"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":51212.36,"maximum":144053.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124950,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":124950,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144053.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":108042.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":108042.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":120892.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":99694.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137222.5,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":51212.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":51724.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":52748.74,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":52236.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":51212.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":51212.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":51212.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":52492.67,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":51212.36,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"minimum":47279.35,"maximum":168799.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101465,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101465,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168799.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126602.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126602.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":98170.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":80956.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":111430.88,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":47279.35,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":47752.15,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":48697.74,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":48224.94,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":47279.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":47279.35,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":47279.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":48461.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":47279.35,"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":61107.54,"maximum":161741.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147276,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147276,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129569.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":97178.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":97178.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":142493.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":117507.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":161741.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":61107.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":61718.62,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":62940.77,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":62329.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":61107.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":61107.54,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":61107.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":62635.23,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":61107.54,"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":42232.78,"maximum":122872.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99671,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99671,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122872.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":92156.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":92156.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":96434.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":79524.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":109460.71,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42232.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42655.11,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43499.77,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43077.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42232.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42232.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42232.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43288.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42232.78,"methodology":"case rate"}]}]},{"description":"MAJOR STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2201","type":"APR-DRG"}],"standard_charges":[{"minimum":8457,"maximum":8457,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8457,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8457,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8457,"methodology":"case rate"}]}]},{"description":"MAJOR STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2202","type":"APR-DRG"}],"standard_charges":[{"minimum":12881,"maximum":12881,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12881,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12881,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12881,"methodology":"case rate"}]}]},{"description":"MAJOR STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2203","type":"APR-DRG"}],"standard_charges":[{"minimum":20066,"maximum":20066,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20066,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20066,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20066,"methodology":"case rate"}]}]},{"description":"MAJOR STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2204","type":"APR-DRG"}],"standard_charges":[{"minimum":38032,"maximum":38032,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38032,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38032,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38032,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"minimum":36787.96,"maximum":151446.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86339,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86339,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151446.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":113587.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":113587.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":83535.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68887.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":94819.6,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":36787.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":37155.84,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":37891.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":37523.72,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":36787.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":36787.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":36787.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":37707.66,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":36787.96,"methodology":"case rate"}]}]},{"description":"OTHER STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2221","type":"APR-DRG"}],"standard_charges":[{"minimum":4815,"maximum":4815,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815,"methodology":"case rate"}]}]},{"description":"OTHER STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2222","type":"APR-DRG"}],"standard_charges":[{"minimum":7736,"maximum":7736,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7736,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7736,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7736,"methodology":"case rate"}]}]},{"description":"OTHER STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2223","type":"APR-DRG"}],"standard_charges":[{"minimum":12914,"maximum":12914,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12914,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12914,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12914,"methodology":"case rate"}]}]},{"description":"OTHER STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2224","type":"APR-DRG"}],"standard_charges":[{"minimum":26122,"maximum":26122,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26122,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26122,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26122,"methodology":"case rate"}]}]},{"description":"OTHER SMALL AND LARGE BOWEL PROCEDURES","code_information":[{"code":"2231","type":"APR-DRG"}],"standard_charges":[{"minimum":6388,"maximum":6388,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6388,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6388,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6388,"methodology":"case rate"}]}]},{"description":"OTHER SMALL AND LARGE BOWEL PROCEDURES","code_information":[{"code":"2232","type":"APR-DRG"}],"standard_charges":[{"minimum":9244,"maximum":9244,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9244,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9244,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9244,"methodology":"case rate"}]}]},{"description":"OTHER SMALL AND LARGE BOWEL PROCEDURES","code_information":[{"code":"2233","type":"APR-DRG"}],"standard_charges":[{"minimum":13860,"maximum":13860,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13860,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13860,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13860,"methodology":"case rate"}]}]},{"description":"OTHER SMALL AND LARGE BOWEL PROCEDURES","code_information":[{"code":"2234","type":"APR-DRG"}],"standard_charges":[{"minimum":25974,"maximum":25974,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25974,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25974,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25974,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS","code_information":[{"code":"2241","type":"APR-DRG"}],"standard_charges":[{"minimum":7345,"maximum":7345,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7345,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7345,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7345,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS","code_information":[{"code":"2242","type":"APR-DRG"}],"standard_charges":[{"minimum":9576,"maximum":9576,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9576,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9576,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9576,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS","code_information":[{"code":"2243","type":"APR-DRG"}],"standard_charges":[{"minimum":13788,"maximum":13788,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13788,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13788,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13788,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS","code_information":[{"code":"2244","type":"APR-DRG"}],"standard_charges":[{"minimum":25325,"maximum":25325,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25325,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25325,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25325,"methodology":"case rate"}]}]},{"description":"ANAL PROCEDURES","code_information":[{"code":"2261","type":"APR-DRG"}],"standard_charges":[{"minimum":5419,"maximum":5419,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5419,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5419,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5419,"methodology":"case rate"}]}]},{"description":"ANAL PROCEDURES","code_information":[{"code":"2262","type":"APR-DRG"}],"standard_charges":[{"minimum":7446,"maximum":7446,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7446,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7446,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7446,"methodology":"case rate"}]}]},{"description":"ANAL PROCEDURES","code_information":[{"code":"2263","type":"APR-DRG"}],"standard_charges":[{"minimum":10828,"maximum":10828,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10828,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10828,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10828,"methodology":"case rate"}]}]},{"description":"ANAL PROCEDURES","code_information":[{"code":"2264","type":"APR-DRG"}],"standard_charges":[{"minimum":25399,"maximum":25399,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25399,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25399,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25399,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL AND UMBILICAL","code_information":[{"code":"2271","type":"APR-DRG"}],"standard_charges":[{"minimum":7150,"maximum":7150,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7150,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7150,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7150,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL AND UMBILICAL","code_information":[{"code":"2272","type":"APR-DRG"}],"standard_charges":[{"minimum":9032,"maximum":9032,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9032,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9032,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9032,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL AND UMBILICAL","code_information":[{"code":"2273","type":"APR-DRG"}],"standard_charges":[{"minimum":13973,"maximum":13973,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13973,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13973,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13973,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL AND UMBILICAL","code_information":[{"code":"2274","type":"APR-DRG"}],"standard_charges":[{"minimum":24857,"maximum":24857,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24857,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24857,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24857,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITH MCC","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"minimum":39809.25,"maximum":129686.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118088,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118088,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119518.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":89640.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":89640.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":114253.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":94219.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":129686.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":39809.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":40207.35,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41003.53,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":40605.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":39809.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39809.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":39809.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40804.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":39809.25,"methodology":"case rate"}]}]},{"description":"INGUINAL FEMORAL AND UMBILICAL HERNIA PROCEDURES","code_information":[{"code":"2281","type":"APR-DRG"}],"standard_charges":[{"minimum":5567,"maximum":5567,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5567,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5567,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5567,"methodology":"case rate"}]}]},{"description":"INGUINAL FEMORAL AND UMBILICAL HERNIA PROCEDURES","code_information":[{"code":"2282","type":"APR-DRG"}],"standard_charges":[{"minimum":7158,"maximum":7158,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7158,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7158,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7158,"methodology":"case rate"}]}]},{"description":"INGUINAL FEMORAL AND UMBILICAL HERNIA PROCEDURES","code_information":[{"code":"2283","type":"APR-DRG"}],"standard_charges":[{"minimum":10699,"maximum":10699,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10699,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10699,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10699,"methodology":"case rate"}]}]},{"description":"INGUINAL FEMORAL AND UMBILICAL HERNIA PROCEDURES","code_information":[{"code":"2284","type":"APR-DRG"}],"standard_charges":[{"minimum":20335,"maximum":20335,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20335,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20335,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20335,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"minimum":25294.38,"maximum":168194.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77110,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77110,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168194.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":126148.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":126148.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":74606.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":61524.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":84684.08,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25294.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25547.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26053.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25800.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25294.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25294.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25294.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25926.74,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25294.38,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES","code_information":[{"code":"2291","type":"APR-DRG"}],"standard_charges":[{"minimum":7049,"maximum":7049,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7049,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7049,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7049,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES","code_information":[{"code":"2292","type":"APR-DRG"}],"standard_charges":[{"minimum":9102,"maximum":9102,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9102,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9102,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9102,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES","code_information":[{"code":"2293","type":"APR-DRG"}],"standard_charges":[{"minimum":13233,"maximum":13233,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13233,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13233,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13233,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES","code_information":[{"code":"2294","type":"APR-DRG"}],"standard_charges":[{"minimum":25842,"maximum":25842,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25842,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25842,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25842,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL BOWEL PROCEDURES","code_information":[{"code":"2301","type":"APR-DRG"}],"standard_charges":[{"minimum":8302,"maximum":8302,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8302,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8302,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8302,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL BOWEL PROCEDURES","code_information":[{"code":"2302","type":"APR-DRG"}],"standard_charges":[{"minimum":11513,"maximum":11513,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11513,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11513,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11513,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL BOWEL PROCEDURES","code_information":[{"code":"2303","type":"APR-DRG"}],"standard_charges":[{"minimum":17014,"maximum":17014,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17014,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17014,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17014,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL BOWEL PROCEDURES","code_information":[{"code":"2304","type":"APR-DRG"}],"standard_charges":[{"minimum":32821,"maximum":32821,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32821,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32821,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32821,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH PTCA WITH MCC","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"minimum":66802.13,"maximum":169403.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154253,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154253,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142738.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":107055.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":107055.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":149244.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":123073.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":169403.24,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":66802.13,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":67470.16,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":68806.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":68138.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":66802.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":66802.13,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":66802.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":68472.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":66802.13,"methodology":"case rate"}]}]},{"description":"MAJOR LARGE BOWEL PROCEDURES","code_information":[{"code":"2311","type":"APR-DRG"}],"standard_charges":[{"minimum":8593,"maximum":8593,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8593,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8593,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8593,"methodology":"case rate"}]}]},{"description":"MAJOR LARGE BOWEL PROCEDURES","code_information":[{"code":"2312","type":"APR-DRG"}],"standard_charges":[{"minimum":10982,"maximum":10982,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10982,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10982,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10982,"methodology":"case rate"}]}]},{"description":"MAJOR LARGE BOWEL PROCEDURES","code_information":[{"code":"2313","type":"APR-DRG"}],"standard_charges":[{"minimum":16917,"maximum":16917,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16917,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16917,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16917,"methodology":"case rate"}]}]},{"description":"MAJOR LARGE BOWEL PROCEDURES","code_information":[{"code":"2314","type":"APR-DRG"}],"standard_charges":[{"minimum":28816,"maximum":28816,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28816,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28816,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28816,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH PTCA WITHOUT MCC","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"minimum":48511.99,"maximum":160040.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112456,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112456,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160040.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":120032.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":120032.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":108804.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":89725.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":123501.49,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":48511.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":48997.11,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":49967.35,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":49482.23,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":48511.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":48511.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":48511.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":49724.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":48511.99,"methodology":"case rate"}]}]},{"description":"GASTRIC FUNDOPLICATION","code_information":[{"code":"2321","type":"APR-DRG"}],"standard_charges":[{"minimum":6141,"maximum":6141,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6141,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6141,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6141,"methodology":"case rate"}]}]},{"description":"GASTRIC FUNDOPLICATION","code_information":[{"code":"2322","type":"APR-DRG"}],"standard_charges":[{"minimum":8118,"maximum":8118,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8118,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8118,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8118,"methodology":"case rate"}]}]},{"description":"GASTRIC FUNDOPLICATION","code_information":[{"code":"2323","type":"APR-DRG"}],"standard_charges":[{"minimum":12795,"maximum":12795,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12795,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12795,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12795,"methodology":"case rate"}]}]},{"description":"GASTRIC FUNDOPLICATION","code_information":[{"code":"2324","type":"APR-DRG"}],"standard_charges":[{"minimum":44021,"maximum":44021,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44021,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44021,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44021,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"minimum":61717.67,"maximum":160272.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145938,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145938,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125790.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":94344.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":94344.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":141199.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":116440.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":160272.4,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":61717.67,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":62334.85,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":63569.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":62952.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":61717.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":61717.67,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":61717.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":63260.62,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":61717.67,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2331","type":"APR-DRG"}],"standard_charges":[{"minimum":6148,"maximum":6148,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6148,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6148,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6148,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2332","type":"APR-DRG"}],"standard_charges":[{"minimum":7993,"maximum":7993,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7993,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7993,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7993,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2333","type":"APR-DRG"}],"standard_charges":[{"minimum":11845,"maximum":11845,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11845,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11845,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11845,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2334","type":"APR-DRG"}],"standard_charges":[{"minimum":19951,"maximum":19951,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19951,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19951,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19951,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"minimum":42414.51,"maximum":129271.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97800,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97800,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129271.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":96955.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":96955.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94624.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":78032.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":107405.96,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42414.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42838.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43686.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43262.81,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42414.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42414.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42414.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43474.88,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42414.51,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2341","type":"APR-DRG"}],"standard_charges":[{"minimum":5519,"maximum":5519,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5519,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5519,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5519,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2342","type":"APR-DRG"}],"standard_charges":[{"minimum":6858,"maximum":6858,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6858,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6858,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2343","type":"APR-DRG"}],"standard_charges":[{"minimum":10226,"maximum":10226,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10226,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10226,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10226,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2344","type":"APR-DRG"}],"standard_charges":[{"minimum":19445,"maximum":19445,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19445,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19445,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"minimum":46775.93,"maximum":121399.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110542,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110542,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93862.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":70398.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":70398.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":106952.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":88198.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":121399.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":46775.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":47243.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":48179.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":47711.45,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":46775.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":46775.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":46775.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":47945.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":46775.93,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"minimum":33072.25,"maximum":83120.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75686,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75686,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73906.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55430.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55430.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":73228.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":60388.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":83120.33,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33072.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":33402.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34064.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33733.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33072.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33072.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33072.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33899.06,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33072.25,"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":40223.74,"maximum":96335.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87720,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87720,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56165.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42124.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42124.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":84871.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":69989.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":96335.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":40223.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":40625.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41430.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":41028.22,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":40223.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":40223.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":40223.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":41229.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":40223.74,"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":23793.4,"maximum":56938.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51846,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51846,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46287.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34716.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34716.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":50163,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":41366.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":56938.8,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23793.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24031.34,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24507.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24269.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23793.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23793.4,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23793.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24388.24,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23793.4,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY","code_information":[{"code":"2401","type":"APR-DRG"}],"standard_charges":[{"minimum":4943,"maximum":4943,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4943,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4943,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4943,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY","code_information":[{"code":"2402","type":"APR-DRG"}],"standard_charges":[{"minimum":5691,"maximum":5691,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5691,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5691,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5691,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY","code_information":[{"code":"2403","type":"APR-DRG"}],"standard_charges":[{"minimum":8037,"maximum":8037,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8037,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8037,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8037,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY","code_information":[{"code":"2404","type":"APR-DRG"}],"standard_charges":[{"minimum":14978,"maximum":14978,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14978,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14978,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14978,"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":12949.39,"maximum":76969.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28483,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28483,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76969.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57728,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57728,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27558.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22726.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31281.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12949.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13078.89,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13337.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13208.38,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12949.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12949.39,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12949.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13273.13,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12949.39,"methodology":"case rate"}]}]},{"description":"PEPTIC ULCER AND GASTRITIS","code_information":[{"code":"2411","type":"APR-DRG"}],"standard_charges":[{"minimum":3901,"maximum":3901,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3901,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3901,"methodology":"case rate"}]}]},{"description":"PEPTIC ULCER AND GASTRITIS","code_information":[{"code":"2412","type":"APR-DRG"}],"standard_charges":[{"minimum":4756,"maximum":4756,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4756,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4756,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4756,"methodology":"case rate"}]}]},{"description":"PEPTIC ULCER AND GASTRITIS","code_information":[{"code":"2413","type":"APR-DRG"}],"standard_charges":[{"minimum":7004,"maximum":7004,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7004,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7004,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7004,"methodology":"case rate"}]}]},{"description":"PEPTIC ULCER AND GASTRITIS","code_information":[{"code":"2414","type":"APR-DRG"}],"standard_charges":[{"minimum":15240,"maximum":15240,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15240,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15240,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15240,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"minimum":27503.7,"maximum":76559.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69713,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69713,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60190.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45143.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45143.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":67449.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":55621.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":76559.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27503.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27778.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28328.82,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28053.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27503.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27503.7,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27503.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28191.3,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27503.7,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS","code_information":[{"code":"2421","type":"APR-DRG"}],"standard_charges":[{"minimum":3546,"maximum":3546,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3546,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3546,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3546,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS","code_information":[{"code":"2422","type":"APR-DRG"}],"standard_charges":[{"minimum":4540,"maximum":4540,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4540,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4540,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4540,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS","code_information":[{"code":"2423","type":"APR-DRG"}],"standard_charges":[{"minimum":6604,"maximum":6604,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6604,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6604,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6604,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS","code_information":[{"code":"2424","type":"APR-DRG"}],"standard_charges":[{"minimum":15416,"maximum":15416,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15416,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15416,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15416,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"minimum":18694.25,"maximum":52181.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47514,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47514,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50468.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37851.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37851.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45971.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37910.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52181.52,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18694.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18881.2,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19068.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18694.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18694.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18694.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19161.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18694.25,"methodology":"case rate"}]}]},{"description":"OTHER ESOPHAGEAL DISORDERS","code_information":[{"code":"2431","type":"APR-DRG"}],"standard_charges":[{"minimum":3611,"maximum":3611,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3611,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3611,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3611,"methodology":"case rate"}]}]},{"description":"OTHER ESOPHAGEAL DISORDERS","code_information":[{"code":"2432","type":"APR-DRG"}],"standard_charges":[{"minimum":4337,"maximum":4337,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4337,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4337,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4337,"methodology":"case rate"}]}]},{"description":"OTHER ESOPHAGEAL DISORDERS","code_information":[{"code":"2433","type":"APR-DRG"}],"standard_charges":[{"minimum":6333,"maximum":6333,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6333,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6333,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6333,"methodology":"case rate"}]}]},{"description":"OTHER ESOPHAGEAL DISORDERS","code_information":[{"code":"2434","type":"APR-DRG"}],"standard_charges":[{"minimum":12531,"maximum":12531,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12531,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12531,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12531,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"minimum":15229.08,"maximum":76813.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38986,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38986,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76813.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57611.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57611.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37720.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31106.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42815.5,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15381.38,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15685.96,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15533.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15609.81,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.08,"methodology":"case rate"}]}]},{"description":"DIVERTICULITIS AND DIVERTICULOSIS","code_information":[{"code":"2441","type":"APR-DRG"}],"standard_charges":[{"minimum":3213,"maximum":3213,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3213,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3213,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3213,"methodology":"case rate"}]}]},{"description":"DIVERTICULITIS AND DIVERTICULOSIS","code_information":[{"code":"2442","type":"APR-DRG"}],"standard_charges":[{"minimum":4264,"maximum":4264,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4264,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4264,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4264,"methodology":"case rate"}]}]},{"description":"DIVERTICULITIS AND DIVERTICULOSIS","code_information":[{"code":"2443","type":"APR-DRG"}],"standard_charges":[{"minimum":6649,"maximum":6649,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6649,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6649,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6649,"methodology":"case rate"}]}]},{"description":"DIVERTICULITIS AND DIVERTICULOSIS","code_information":[{"code":"2444","type":"APR-DRG"}],"standard_charges":[{"minimum":12833,"maximum":12833,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12833,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12833,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12833,"methodology":"case rate"}]}]},{"description":"AICD GENERATOR PROCEDURES","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"minimum":39063.02,"maximum":107436.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97828,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97828,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56490.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42368.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42368.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94651.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":78054.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":107436.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":39063.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":39453.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":40234.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":39844.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":39063.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39063.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":39063.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40039.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":39063.02,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE","code_information":[{"code":"2451","type":"APR-DRG"}],"standard_charges":[{"minimum":3620,"maximum":3620,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3620,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3620,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3620,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE","code_information":[{"code":"2452","type":"APR-DRG"}],"standard_charges":[{"minimum":4594,"maximum":4594,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4594,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4594,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4594,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE","code_information":[{"code":"2453","type":"APR-DRG"}],"standard_charges":[{"minimum":6920,"maximum":6920,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6920,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6920,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6920,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE","code_information":[{"code":"2454","type":"APR-DRG"}],"standard_charges":[{"minimum":13080,"maximum":13080,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13080,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13080,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13080,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL VASCULAR INSUFFICIENCY","code_information":[{"code":"2461","type":"APR-DRG"}],"standard_charges":[{"minimum":3651,"maximum":3651,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3651,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3651,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3651,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL VASCULAR INSUFFICIENCY","code_information":[{"code":"2462","type":"APR-DRG"}],"standard_charges":[{"minimum":4547,"maximum":4547,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL VASCULAR INSUFFICIENCY","code_information":[{"code":"2463","type":"APR-DRG"}],"standard_charges":[{"minimum":6955,"maximum":6955,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6955,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6955,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL VASCULAR INSUFFICIENCY","code_information":[{"code":"2464","type":"APR-DRG"}],"standard_charges":[{"minimum":12136,"maximum":12136,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12136,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12136,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12136,"methodology":"case rate"}]}]},{"description":"INTESTINAL OBSTRUCTION","code_information":[{"code":"2471","type":"APR-DRG"}],"standard_charges":[{"minimum":2947,"maximum":2947,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2947,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2947,"methodology":"case rate"}]}]},{"description":"INTESTINAL OBSTRUCTION","code_information":[{"code":"2472","type":"APR-DRG"}],"standard_charges":[{"minimum":3922,"maximum":3922,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3922,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3922,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3922,"methodology":"case rate"}]}]},{"description":"INTESTINAL OBSTRUCTION","code_information":[{"code":"2473","type":"APR-DRG"}],"standard_charges":[{"minimum":6350,"maximum":6350,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6350,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6350,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6350,"methodology":"case rate"}]}]},{"description":"INTESTINAL OBSTRUCTION","code_information":[{"code":"2474","type":"APR-DRG"}],"standard_charges":[{"minimum":12138,"maximum":12138,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12138,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12138,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12138,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS","code_information":[{"code":"2481","type":"APR-DRG"}],"standard_charges":[{"minimum":3276,"maximum":3276,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3276,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3276,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS","code_information":[{"code":"2482","type":"APR-DRG"}],"standard_charges":[{"minimum":4453,"maximum":4453,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4453,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4453,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4453,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS","code_information":[{"code":"2483","type":"APR-DRG"}],"standard_charges":[{"minimum":6773,"maximum":6773,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6773,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6773,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6773,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS","code_information":[{"code":"2484","type":"APR-DRG"}],"standard_charges":[{"minimum":13241,"maximum":13241,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13241,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13241,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13241,"methodology":"case rate"}]}]},{"description":"OTHER GASTROENTERITIS NAUSEA AND VOMITING","code_information":[{"code":"2491","type":"APR-DRG"}],"standard_charges":[{"minimum":2971,"maximum":2971,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2971,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2971,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2971,"methodology":"case rate"}]}]},{"description":"OTHER GASTROENTERITIS NAUSEA AND VOMITING","code_information":[{"code":"2492","type":"APR-DRG"}],"standard_charges":[{"minimum":3543,"maximum":3543,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3543,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3543,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3543,"methodology":"case rate"}]}]},{"description":"OTHER GASTROENTERITIS NAUSEA AND VOMITING","code_information":[{"code":"2493","type":"APR-DRG"}],"standard_charges":[{"minimum":5212,"maximum":5212,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5212,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5212,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5212,"methodology":"case rate"}]}]},{"description":"OTHER GASTROENTERITIS NAUSEA AND VOMITING","code_information":[{"code":"2494","type":"APR-DRG"}],"standard_charges":[{"minimum":10633,"maximum":10633,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10633,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10633,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10633,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"minimum":19156.68,"maximum":52608.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47903,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47903,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36361.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27271.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27271.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":46348.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38220.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52608.56,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19156.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19348.25,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19731.39,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19539.82,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19156.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19156.68,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19156.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19635.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19156.68,"methodology":"case rate"}]}]},{"description":"PHARMACY - GENERAL","code_information":[{"code":"250","type":"RC"}],"standard_charges":[{"minimum":59.32,"maximum":79.08,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"minimum":13356.92,"maximum":64495.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31615,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31615,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64495.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48372.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48372.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30588.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25224.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34720.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13356.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13490.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13757.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13624.06,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13356.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13356.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13356.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13690.85,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13356.92,"methodology":"case rate"}]}]},{"description":"PHARMACY - GENERIC DRUGS","code_information":[{"code":"251","type":"RC"}],"standard_charges":[{"minimum":59.32,"maximum":79.08,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABDOMINAL PAIN","code_information":[{"code":"2511","type":"APR-DRG"}],"standard_charges":[{"minimum":3331,"maximum":3331,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3331,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3331,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3331,"methodology":"case rate"}]}]},{"description":"ABDOMINAL PAIN","code_information":[{"code":"2512","type":"APR-DRG"}],"standard_charges":[{"minimum":3992,"maximum":3992,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3992,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3992,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3992,"methodology":"case rate"}]}]},{"description":"ABDOMINAL PAIN","code_information":[{"code":"2513","type":"APR-DRG"}],"standard_charges":[{"minimum":5304,"maximum":5304,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5304,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5304,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5304,"methodology":"case rate"}]}]},{"description":"ABDOMINAL PAIN","code_information":[{"code":"2514","type":"APR-DRG"}],"standard_charges":[{"minimum":10008,"maximum":10008,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10008,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10008,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10008,"methodology":"case rate"}]}]},{"description":"OTHER VASCULAR PROCEDURES WITH MCC","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"minimum":27800.65,"maximum":67674.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61622,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61622,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52731.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39549.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39549.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":59621.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":49166.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":67674.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27800.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28078.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28634.67,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28356.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27800.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27800.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27800.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28495.67,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27800.65,"methodology":"case rate"}]}]},{"description":"PHARMACY - NON-GENERIC DRUGS","code_information":[{"code":"252","type":"RC"}],"standard_charges":[{"minimum":59.32,"maximum":79.08,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MALFUNCTION REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE","code_information":[{"code":"2521","type":"APR-DRG"}],"standard_charges":[{"minimum":3780,"maximum":3780,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3780,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3780,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3780,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE","code_information":[{"code":"2522","type":"APR-DRG"}],"standard_charges":[{"minimum":4772,"maximum":4772,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4772,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4772,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4772,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE","code_information":[{"code":"2523","type":"APR-DRG"}],"standard_charges":[{"minimum":7276,"maximum":7276,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7276,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7276,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE","code_information":[{"code":"2524","type":"APR-DRG"}],"standard_charges":[{"minimum":15408,"maximum":15408,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15408,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15408,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15408,"methodology":"case rate"}]}]},{"description":"OTHER VASCULAR PROCEDURES WITH CC","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"minimum":21015.7,"maximum":53774.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48964,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48964,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39278.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29459.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29459.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":47374.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39067.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":53774.15,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21015.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21225.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21646.18,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21436.02,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21015.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21015.7,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21015.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21541.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21015.7,"methodology":"case rate"}]}]},{"description":"PHARMACY - TAKE HOME DRUGS","code_information":[{"code":"253","type":"RC"}],"standard_charges":[{"minimum":14.83,"maximum":19.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE","code_information":[{"code":"2531","type":"APR-DRG"}],"standard_charges":[{"minimum":3624,"maximum":3624,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3624,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3624,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3624,"methodology":"case rate"}]}]},{"description":"OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE","code_information":[{"code":"2532","type":"APR-DRG"}],"standard_charges":[{"minimum":4575,"maximum":4575,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4575,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4575,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4575,"methodology":"case rate"}]}]},{"description":"OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE","code_information":[{"code":"2533","type":"APR-DRG"}],"standard_charges":[{"minimum":6795,"maximum":6795,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6795,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6795,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6795,"methodology":"case rate"}]}]},{"description":"OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE","code_information":[{"code":"2534","type":"APR-DRG"}],"standard_charges":[{"minimum":12108,"maximum":12108,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12108,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12108,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12108,"methodology":"case rate"}]}]},{"description":"OTHER VASCULAR PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"minimum":14801.44,"maximum":46726.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34190,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34190,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46726.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35045.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35045.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33080.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27279.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37548.66,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14801.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14949.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15245.49,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15097.47,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14801.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14801.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14801.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15171.48,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14801.44,"methodology":"case rate"}]}]},{"description":"PHARMACY - DRUGS INCIDENT TO OTHER DIAGNOSTIC SERVICES","code_information":[{"code":"254","type":"RC"}],"standard_charges":[{"minimum":14.83,"maximum":19.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES","code_information":[{"code":"2541","type":"APR-DRG"}],"standard_charges":[{"minimum":3402,"maximum":3402,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3402,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3402,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3402,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES","code_information":[{"code":"2542","type":"APR-DRG"}],"standard_charges":[{"minimum":4388,"maximum":4388,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4388,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4388,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4388,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES","code_information":[{"code":"2543","type":"APR-DRG"}],"standard_charges":[{"minimum":6497,"maximum":6497,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6497,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6497,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6497,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES","code_information":[{"code":"2544","type":"APR-DRG"}],"standard_charges":[{"minimum":12367,"maximum":12367,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12367,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12367,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12367,"methodology":"case rate"}]}]},{"description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","code_information":[{"code":"255","type":"RC"}],"standard_charges":[{"minimum":14.83,"maximum":19.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"minimum":21506.74,"maximum":54661.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49772,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49772,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36638.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27479.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27479.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":48156.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39712.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54661.24,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21506.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21721.81,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22151.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21936.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21506.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21506.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21506.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22044.41,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21506.74,"methodology":"case rate"}]}]},{"description":"PHARMACY - EXPERIMENTAL DRUGS","code_information":[{"code":"256","type":"RC"}],"standard_charges":[{"minimum":14.83,"maximum":19.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"minimum":14370.71,"maximum":35411.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32244,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32244,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30425.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22819.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22819.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31197.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25726.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35411.39,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14370.71,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14514.42,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14801.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14658.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14370.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14370.71,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14370.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14729.98,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14370.71,"methodology":"case rate"}]}]},{"description":"PHARMACY - NON-PRESCRIPTION","code_information":[{"code":"257","type":"RC"}],"standard_charges":[{"minimum":14.83,"maximum":19.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"minimum":8170.38,"maximum":54299.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21309,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21309,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54299.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40725.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40725.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20617.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17002.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23402.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8170.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8252.09,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8415.5,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8333.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8170.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8170.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8170.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8374.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8170.38,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"minimum":22968.28,"maximum":63100.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57457,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57457,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39206.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29405.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29405.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":55591.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":45843.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":63100.98,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22968.28,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23197.97,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23657.33,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23427.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22968.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22968.28,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22968.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23542.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22968.28,"methodology":"case rate"}]}]},{"description":"PHARMACY - IV SOLUTIONS","code_information":[{"code":"258","type":"RC"}],"standard_charges":[{"minimum":59.32,"maximum":79.08,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"minimum":14865.63,"maximum":42964.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39121,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39121,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41978.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31484.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31484.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37851.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31214,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42964.03,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14865.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15014.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15311.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15162.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14865.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14865.63,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14865.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15237.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14865.63,"methodology":"case rate"}]}]},{"description":"PHARMACY - OTHER","code_information":[{"code":"259","type":"RC"}],"standard_charges":[{"minimum":14.83,"maximum":19.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"minimum":19234.88,"maximum":76322.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69496,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69496,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25646.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19234.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19234.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":67240.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":55449.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":76322.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27613.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27889.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28441.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28165.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27613.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27613.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27613.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28303.85,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27613.51,"methodology":"case rate"}]}]},{"description":"IV THERAPY","code_information":[{"code":"260","type":"RC"}],"standard_charges":[{"minimum":179,"maximum":206,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":206,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":179,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205,"methodology":"case rate"}]}]},{"description":"MAJOR PANCREAS LIVER AND SHUNT PROCEDURES","code_information":[{"code":"2601","type":"APR-DRG"}],"standard_charges":[{"minimum":11499,"maximum":11499,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11499,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11499,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11499,"methodology":"case rate"}]}]},{"description":"MAJOR PANCREAS LIVER AND SHUNT PROCEDURES","code_information":[{"code":"2602","type":"APR-DRG"}],"standard_charges":[{"minimum":14527,"maximum":14527,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14527,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14527,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14527,"methodology":"case rate"}]}]},{"description":"MAJOR PANCREAS LIVER AND SHUNT PROCEDURES","code_information":[{"code":"2603","type":"APR-DRG"}],"standard_charges":[{"minimum":21164,"maximum":21164,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21164,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21164,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21164,"methodology":"case rate"}]}]},{"description":"MAJOR PANCREAS LIVER AND SHUNT PROCEDURES","code_information":[{"code":"2604","type":"APR-DRG"}],"standard_charges":[{"minimum":44791,"maximum":44791,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44791,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44791,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44791,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"minimum":15947.48,"maximum":40197.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36602,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36602,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21828.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16371.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16371.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35413.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29204.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40197.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16106.96,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16425.91,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16266.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16346.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"}]}]},{"description":"MAJOR BILIARY TRACT PROCEDURES","code_information":[{"code":"2611","type":"APR-DRG"}],"standard_charges":[{"minimum":8839,"maximum":8839,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8839,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8839,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8839,"methodology":"case rate"}]}]},{"description":"MAJOR BILIARY TRACT PROCEDURES","code_information":[{"code":"2612","type":"APR-DRG"}],"standard_charges":[{"minimum":12250,"maximum":12250,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12250,"methodology":"case rate"}]}]},{"description":"MAJOR BILIARY TRACT PROCEDURES","code_information":[{"code":"2613","type":"APR-DRG"}],"standard_charges":[{"minimum":18317,"maximum":18317,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18317,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18317,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18317,"methodology":"case rate"}]}]},{"description":"MAJOR BILIARY TRACT PROCEDURES","code_information":[{"code":"2614","type":"APR-DRG"}],"standard_charges":[{"minimum":35199,"maximum":35199,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35199,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35199,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35199,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"minimum":13010.48,"maximum":34608.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31513,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31513,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19042.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14282.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14282.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30490.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25143.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34608.88,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13010.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13140.59,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13400.8,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13270.69,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13010.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13010.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13010.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13335.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13010.48,"methodology":"case rate"}]}]},{"description":"IV THERAPY - PHARMACY SERVICES","code_information":[{"code":"262","type":"RC"}],"standard_charges":[{"minimum":74.17,"maximum":98.88,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VEIN LIGATION AND STRIPPING","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"minimum":22014.03,"maximum":48668.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44315,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44315,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46221.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34666.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34666.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":42876.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":35358.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":48668.23,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22014.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22234.18,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22674.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22454.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22014.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22014.03,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22014.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22564.39,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22014.03,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY","code_information":[{"code":"2631","type":"APR-DRG"}],"standard_charges":[{"minimum":6576,"maximum":6576,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6576,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6576,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6576,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY","code_information":[{"code":"2632","type":"APR-DRG"}],"standard_charges":[{"minimum":8293,"maximum":8293,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8293,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8293,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8293,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY","code_information":[{"code":"2633","type":"APR-DRG"}],"standard_charges":[{"minimum":10846,"maximum":10846,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10846,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10846,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY","code_information":[{"code":"2634","type":"APR-DRG"}],"standard_charges":[{"minimum":22065,"maximum":22065,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22065,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22065,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22065,"methodology":"case rate"}]}]},{"description":"IV THERAPY - SUPPLIES","code_information":[{"code":"264","type":"RC"}],"standard_charges":[{"minimum":254.69,"maximum":339.52,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":339.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":254.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":254.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER CIRCULATORY SYSTEM O.R. PROCEDURES","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"minimum":28300.97,"maximum":76813.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60825,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60825,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76813.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57611.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57611.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":58850.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":48531.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":66799.94,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28300.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28583.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29150,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28866.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28300.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28300.97,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28300.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29008.5,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28300.97,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY PANCREAS AND ABDOMINAL PROCEDURES","code_information":[{"code":"2641","type":"APR-DRG"}],"standard_charges":[{"minimum":8589,"maximum":8589,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8589,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8589,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8589,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY PANCREAS AND ABDOMINAL PROCEDURES","code_information":[{"code":"2642","type":"APR-DRG"}],"standard_charges":[{"minimum":8646,"maximum":8646,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8646,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8646,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8646,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY PANCREAS AND ABDOMINAL PROCEDURES","code_information":[{"code":"2643","type":"APR-DRG"}],"standard_charges":[{"minimum":9872,"maximum":9872,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9872,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9872,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9872,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY PANCREAS AND ABDOMINAL PROCEDURES","code_information":[{"code":"2644","type":"APR-DRG"}],"standard_charges":[{"minimum":25786,"maximum":25786,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25786,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25786,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25786,"methodology":"case rate"}]}]},{"description":"AICD LEAD PROCEDURES","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"minimum":28858.53,"maximum":184481.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58633,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58633,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184481.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":138363.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":138363.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":56729.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":46782.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64392.41,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28858.53,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29147.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29724.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29435.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28858.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28858.53,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28858.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29580,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28858.53,"methodology":"case rate"}]}]},{"description":"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"minimum":47600.27,"maximum":169838.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133775,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133775,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169838.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":127381.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":127381.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":129431.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":106735.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":146914.48,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":47600.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":48076.28,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":49028.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":48552.28,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":47600.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":47600.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":47600.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":48790.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":47600.27,"methodology":"case rate"}]}]},{"description":"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"minimum":37654.83,"maximum":117087.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106616,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106616,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117064.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":87800.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":87800.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":103154.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":85065.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":117087.62,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37654.83,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38031.38,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38784.48,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38407.93,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37654.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37654.83,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37654.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38596.21,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37654.83,"methodology":"case rate"}]}]},{"description":"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"minimum":52833.98,"maximum":139925.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127411,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127411,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76650.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57489.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57489.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":123273.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":101657.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":139925.03,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":52833.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":53362.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":54419,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":53890.66,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":52833.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":52833.98,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":52833.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":54154.83,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":52833.98,"methodology":"case rate"}]}]},{"description":"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"minimum":33448.07,"maximum":88252.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80144,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80144,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88252.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":66190.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":66190.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":77541.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63944.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":88015.83,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33448.07,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":33782.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34451.52,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34117.04,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33448.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33448.07,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33448.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34284.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33448.07,"methodology":"case rate"}]}]},{"description":"IV THERAPY","code_information":[{"code":"269","type":"RC"}],"standard_charges":[{"minimum":179,"maximum":206,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":206,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":179,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"minimum":40966.89,"maximum":105423.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95995,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95995,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61699.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46275.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46275.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":92877.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":76591.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":105423.42,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":40966.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":41376.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":42195.9,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":41786.23,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":40966.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":40966.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":40966.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":41991.07,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":40966.89,"methodology":"case rate"}]}]},{"description":"SUPPLIES - GENERAL","code_information":[{"code":"270","type":"RC"}],"standard_charges":[{"minimum":207.62,"maximum":276.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NONSTERILE SUPPLY","code_information":[{"code":"271","type":"RC"}],"standard_charges":[{"minimum":207.62,"maximum":276.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"minimum":27908.91,"maximum":73195.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66649,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66649,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44190.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33143.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33143.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":64484.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":53177.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":73195.24,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27908.91,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28188,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28746.18,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28467.09,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27908.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27908.91,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27908.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28606.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27908.91,"methodology":"case rate"}]}]},{"description":"INST/SUPP NONST 39X-51","code_information":[{"code":"2711000817","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":190.8,"maximum":294.12,"gross_charge":360,"discounted_cash":82.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 39X-51","code_information":[{"code":"2711000817","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":50.4,"maximum":294.12,"gross_charge":360,"discounted_cash":82.44,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 51X-67","code_information":[{"code":"2711000818","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":218.89,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 51X-67","code_information":[{"code":"2711000818","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":57.82,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 88X-115","code_information":[{"code":"2711000819","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":322.77,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 88X-115","code_information":[{"code":"2711000819","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":85.26,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST2087X-2714","code_information":[{"code":"2711000820","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":3180.53,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST2087X-2714","code_information":[{"code":"2711000820","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":840.14,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 10-13","code_information":[{"code":"2711000912","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 10-13","code_information":[{"code":"2711000912","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 30X-39","code_information":[{"code":"2711000913","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 30X-39","code_information":[{"code":"2711000913","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":38.64,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 115X-150","code_information":[{"code":"2711000982","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":421.35,"maximum":649.52,"gross_charge":795,"discounted_cash":182.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":421.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":649.52,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 115X-150","code_information":[{"code":"2711000982","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":111.3,"maximum":649.52,"gross_charge":795,"discounted_cash":182.06,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":421.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":649.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 17X-23","code_information":[{"code":"2711003225","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":32.86,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP NONST 17X-23","code_information":[{"code":"2711003225","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"minimum":8.68,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"minimum":20622.86,"maximum":74342.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48865,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48865,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74342.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55757.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55757.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":47278.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38988.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":53664.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20622.86,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20829.09,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21241.55,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21035.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20622.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20622.86,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20622.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21138.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20622.86,"methodology":"case rate"}]}]},{"description":"STERILE SUPPLY","code_information":[{"code":"272","type":"RC"}],"standard_charges":[{"minimum":533.88,"maximum":711.72,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":533.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":533.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CATH OTHER 10-13","code_information":[{"code":"2721000753","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 10-13","code_information":[{"code":"2721000753","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 13X-17","code_information":[{"code":"2721000754","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":63.6,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 13X-17","code_information":[{"code":"2721000754","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.8,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 17X-23","code_information":[{"code":"2721000755","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":84.8,"maximum":130.72,"gross_charge":160,"discounted_cash":36.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 17X-23","code_information":[{"code":"2721000755","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.4,"maximum":130.72,"gross_charge":160,"discounted_cash":36.64,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 23X-30","code_information":[{"code":"2721000756","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":112.36,"maximum":173.21,"gross_charge":212,"discounted_cash":48.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":173.21,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 23X-30","code_information":[{"code":"2721000756","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":173.21,"gross_charge":212,"discounted_cash":48.55,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":173.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 30X-39","code_information":[{"code":"2721000757","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 30X-39","code_information":[{"code":"2721000757","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":38.64,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 51X-67","code_information":[{"code":"2721000758","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":218.89,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 51X-67","code_information":[{"code":"2721000758","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":57.82,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 67X-88","code_information":[{"code":"2721000759","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":287.79,"maximum":443.64,"gross_charge":543,"discounted_cash":124.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 67X-88","code_information":[{"code":"2721000759","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":76.02,"maximum":443.64,"gross_charge":543,"discounted_cash":124.35,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 150X-195","code_information":[{"code":"2721000760","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":548.55,"maximum":845.6,"gross_charge":1035,"discounted_cash":237.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":548.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":845.6,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 150X-195","code_information":[{"code":"2721000760","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":144.9,"maximum":845.6,"gross_charge":1035,"discounted_cash":237.02,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":548.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":845.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.9,"methodology":"fee schedule"}]}]},{"description":"CLOSURE EXTERN 39X-51","code_information":[{"code":"2721000771","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":190.8,"maximum":294.12,"gross_charge":360,"discounted_cash":82.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"}]}]},{"description":"CLOSURE EXTERN 39X-51","code_information":[{"code":"2721000771","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":50.4,"maximum":294.12,"gross_charge":360,"discounted_cash":82.44,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"}]}]},{"description":"CLOSURE EXTERN 88X-115","code_information":[{"code":"2721000774","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":322.77,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"}]}]},{"description":"CLOSURE EXTERN 88X-115","code_information":[{"code":"2721000774","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":85.26,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"}]}]},{"description":"CLOSURE EXTERN 115X-150","code_information":[{"code":"2721000775","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":421.35,"maximum":649.52,"gross_charge":795,"discounted_cash":182.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":421.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":649.52,"methodology":"fee schedule"}]}]},{"description":"CLOSURE EXTERN 115X-150","code_information":[{"code":"2721000775","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":111.3,"maximum":649.52,"gross_charge":795,"discounted_cash":182.06,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":421.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":649.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 254X-331","code_information":[{"code":"2721000799","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":930.15,"maximum":1433.84,"gross_charge":1755,"discounted_cash":401.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":930.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1433.84,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 254X-331","code_information":[{"code":"2721000799","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":245.7,"maximum":1433.84,"gross_charge":1755,"discounted_cash":401.9,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":930.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1433.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.7,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 331X-431","code_information":[{"code":"2721000800","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1211.58,"maximum":1867.67,"gross_charge":2286,"discounted_cash":523.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1211.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1867.67,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 331X-431","code_information":[{"code":"2721000800","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":320.04,"maximum":1867.67,"gross_charge":2286,"discounted_cash":523.5,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1211.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1867.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.04,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 431X-561","code_information":[{"code":"2721000801","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1577.28,"maximum":2431.4,"gross_charge":2976,"discounted_cash":681.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1577.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2431.4,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 431X-561","code_information":[{"code":"2721000801","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":416.64,"maximum":2431.4,"gross_charge":2976,"discounted_cash":681.51,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1577.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2431.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.64,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 195X-254","code_information":[{"code":"2721000832","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":713.91,"maximum":1100.5,"gross_charge":1347,"discounted_cash":308.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":713.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1100.5,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 195X-254","code_information":[{"code":"2721000832","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":188.58,"maximum":1100.5,"gross_charge":1347,"discounted_cash":308.47,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":713.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1100.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 561X-730","code_information":[{"code":"2721000836","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1710.84,"maximum":2637.28,"gross_charge":3228,"discounted_cash":739.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1710.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2637.28,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 561X-730","code_information":[{"code":"2721000836","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":451.92,"maximum":2637.28,"gross_charge":3228,"discounted_cash":739.22,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1710.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2637.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.92,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 730X-949","code_information":[{"code":"2721000837","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2224.94,"maximum":3429.77,"gross_charge":4198,"discounted_cash":961.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2224.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3429.77,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 730X-949","code_information":[{"code":"2721000837","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":587.72,"maximum":3429.77,"gross_charge":4198,"discounted_cash":961.35,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2224.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3429.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.72,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 949X-1234","code_information":[{"code":"2721000838","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2603.36,"maximum":4013.11,"gross_charge":4912,"discounted_cash":1124.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2603.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4013.11,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 949X-1234","code_information":[{"code":"2721000838","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":687.68,"maximum":4013.11,"gross_charge":4912,"discounted_cash":1124.85,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2603.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4013.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.68,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL1234X-1605","code_information":[{"code":"2721000839","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3385.64,"maximum":5219,"gross_charge":6388,"discounted_cash":1462.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3385.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5219,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL1234X-1605","code_information":[{"code":"2721000839","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":894.32,"maximum":5219,"gross_charge":6388,"discounted_cash":1462.86,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3385.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5219,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL1605X-2087","code_information":[{"code":"2721000840","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4402.71,"maximum":6786.82,"gross_charge":8307,"discounted_cash":1902.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4402.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6786.82,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL1605X-2087","code_information":[{"code":"2721000840","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1162.98,"maximum":6786.82,"gross_charge":8307,"discounted_cash":1902.31,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4402.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6786.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.98,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION2087X-2714","code_information":[{"code":"2721002298","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3180.53,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION2087X-2714","code_information":[{"code":"2721002298","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":840.14,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION2714X-3529","code_information":[{"code":"2721002531","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4136.12,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION2714X-3529","code_information":[{"code":"2721002531","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1092.56,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 1605X-2087","code_information":[{"code":"2721002616","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4891.9,"maximum":7540.91,"gross_charge":9230,"discounted_cash":2113.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4891.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7540.91,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 1605X-2087","code_information":[{"code":"2721002616","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1292.2,"maximum":7540.91,"gross_charge":9230,"discounted_cash":2113.67,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4891.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7540.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1292.2,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 39X-51","code_information":[{"code":"2721002945","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 39X-51","code_information":[{"code":"2721002945","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 150X-195","code_information":[{"code":"2721002960","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":353.51,"maximum":544.94,"gross_charge":667,"discounted_cash":152.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":353.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":544.94,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 150X-195","code_information":[{"code":"2721002960","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":93.38,"maximum":544.94,"gross_charge":667,"discounted_cash":152.75,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":353.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":544.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.38,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 67X-88","code_information":[{"code":"2721002997","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":164.83,"maximum":254.09,"gross_charge":311,"discounted_cash":71.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":164.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.09,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 67X-88","code_information":[{"code":"2721002997","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":43.54,"maximum":254.09,"gross_charge":311,"discounted_cash":71.22,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":164.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"}]}]},{"description":"KIT/PACK DISP 331X-431","code_information":[{"code":"2721003006","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":894.64,"maximum":1379.1,"gross_charge":1688,"discounted_cash":386.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":894.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1379.1,"methodology":"fee schedule"}]}]},{"description":"KIT/PACK DISP 331X-431","code_information":[{"code":"2721003006","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":236.32,"maximum":1379.1,"gross_charge":1688,"discounted_cash":386.56,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":894.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1379.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.32,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STE13419X-14761","code_information":[{"code":"2721003022","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":30740,"maximum":47386,"gross_charge":58000,"discounted_cash":13282,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30740,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47386,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STE13419X-14761","code_information":[{"code":"2721003022","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8120,"maximum":47386,"gross_charge":58000,"discounted_cash":13282,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30740,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47386,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8120,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8120,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8120,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 115X-150","code_information":[{"code":"2721003029","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":273.48,"maximum":421.58,"gross_charge":516,"discounted_cash":118.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":273.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":421.58,"methodology":"fee schedule"}]}]},{"description":"EXTERN FIXATION 115X-150","code_information":[{"code":"2721003029","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":72.24,"maximum":421.58,"gross_charge":516,"discounted_cash":118.17,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":273.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":421.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 949X-1234","code_information":[{"code":"2721003033","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2014,"maximum":3104.6,"gross_charge":3800,"discounted_cash":870.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2014,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3104.6,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 949X-1234","code_information":[{"code":"2721003033","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":532,"maximum":3104.6,"gross_charge":3800,"discounted_cash":870.2,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2014,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3104.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":532,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":532,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":532,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 88X-115","code_information":[{"code":"2721003041","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":233.2,"maximum":359.48,"gross_charge":440,"discounted_cash":100.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":233.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":359.48,"methodology":"fee schedule"}]}]},{"description":"CATH OTHER 88X-115","code_information":[{"code":"2721003041","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":61.6,"maximum":359.48,"gross_charge":440,"discounted_cash":100.76,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":233.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":359.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.6,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 2714X-3529","code_information":[{"code":"2721003179","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6014.44,"maximum":9271.32,"gross_charge":11348,"discounted_cash":2598.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6014.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9271.32,"methodology":"fee schedule"}]}]},{"description":"INST/SUPP STERL 2714X-3529","code_information":[{"code":"2721003179","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1588.72,"maximum":9271.32,"gross_charge":11348,"discounted_cash":2598.7,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6014.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9271.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1588.72,"methodology":"fee schedule"}]}]},{"description":"KIT/PACK DISP 730X-949","code_information":[{"code":"2721003192","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1769.14,"maximum":2727.15,"gross_charge":3338,"discounted_cash":764.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1769.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2727.15,"methodology":"fee schedule"}]}]},{"description":"KIT/PACK DISP 730X-949","code_information":[{"code":"2721003192","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":467.32,"maximum":2727.15,"gross_charge":3338,"discounted_cash":764.41,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1769.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2727.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.32,"methodology":"fee schedule"}]}]},{"description":"KIT/PACK DISP 561X-730","code_information":[{"code":"2721003222","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1337.19,"maximum":2061.3,"gross_charge":2523,"discounted_cash":577.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1337.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2061.3,"methodology":"fee schedule"}]}]},{"description":"KIT/PACK DISP 561X-730","code_information":[{"code":"2721003222","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":353.22,"maximum":2061.3,"gross_charge":2523,"discounted_cash":577.77,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1337.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2061.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.22,"methodology":"fee schedule"}]}]},{"description":"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"minimum":31511.72,"maximum":76543.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69697,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69697,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52178.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39134.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39134.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":67434.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":55609.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":76543.48,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31511.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31826.84,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32457.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32141.96,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31511.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31511.72,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31511.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32299.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31511.72,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"minimum":25408.05,"maximum":211024.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59356,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59356,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":211024.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":158271.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":158271.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":57429.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47359.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65186.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25408.05,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25662.14,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26170.3,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25916.22,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25408.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25408.05,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25408.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26043.26,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25408.05,"methodology":"case rate"}]}]},{"description":"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"minimum":55922.55,"maximum":127423.64,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127423.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":95569.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":95569.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":55922.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":56481.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":57600.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":57041.01,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":55922.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":55922.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":55922.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":57320.62,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":55922.55,"methodology":"case rate"}]}]},{"description":"PACE MAKER","code_information":[{"code":"275","type":"RC"}],"standard_charges":[{"minimum":18626.48,"maximum":24831.12,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24831.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18626.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18626.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"minimum":49174.71,"maximum":109959.43,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109959.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":82471.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":82471.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":49174.71,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49666.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50649.96,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":50158.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":49174.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":49174.71,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":49174.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50404.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":49174.71,"methodology":"case rate"}]}]},{"description":"CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"minimum":37246.53,"maximum":57642.95,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57642.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43233.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43233.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37246.53,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":37619,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38363.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":37991.47,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37246.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37246.53,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37246.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38177.7,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37246.53,"methodology":"case rate"}]}]},{"description":"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"minimum":31105.47,"maximum":41473.16,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41473.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31105.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31105.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":39963.91,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":40363.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41162.83,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":40763.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":39963.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39963.91,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":39963.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40963.01,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":39963.91,"methodology":"case rate"}]}]},{"description":"CLOSURE IMPLNT 30X-39","code_information":[{"code":"2781000777","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 30X-39","code_information":[{"code":"2781000777","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":19.46,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 51X-67","code_information":[{"code":"2781000778","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.14,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 51X-67","code_information":[{"code":"2781000778","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":33.32,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.66,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":51.65,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 67X-88","code_information":[{"code":"2781000779","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.89,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 67X-88","code_information":[{"code":"2781000779","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":43.82,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.21,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.93,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 88X-115","code_information":[{"code":"2781000780","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":110.24,"maximum":169.94,"gross_charge":208,"discounted_cash":47.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":110.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.94,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 88X-115","code_information":[{"code":"2781000780","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":29.12,"maximum":169.94,"gross_charge":208,"discounted_cash":47.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.04,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45.14,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":110.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 115X-150","code_information":[{"code":"2781000781","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":283.55,"maximum":437.1,"gross_charge":535,"discounted_cash":122.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 115X-150","code_information":[{"code":"2781000781","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":74.9,"maximum":437.1,"gross_charge":535,"discounted_cash":122.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 150X-195","code_information":[{"code":"2781000782","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 150X-195","code_information":[{"code":"2781000782","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":97.58,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 195X-254","code_information":[{"code":"2781000783","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 195X-254","code_information":[{"code":"2781000783","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.98,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 331X-431","code_information":[{"code":"2781000784","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":815.67,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 331X-431","code_information":[{"code":"2781000784","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":215.46,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 431X-561","code_information":[{"code":"2781000785","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1062.12,"maximum":1637.27,"gross_charge":2004,"discounted_cash":458.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 431X-561","code_information":[{"code":"2781000785","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":280.56,"maximum":1637.27,"gross_charge":2004,"discounted_cash":458.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 2087X-2714","code_information":[{"code":"2781000786","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3180.53,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 2087X-2714","code_information":[{"code":"2781000786","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":840.14,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 39X-51","code_information":[{"code":"2781000905","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 39X-51","code_information":[{"code":"2781000905","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":25.48,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 254X-331","code_information":[{"code":"2781000906","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 254X-331","code_information":[{"code":"2781000906","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 561X-730","code_information":[{"code":"2781000907","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1382.24,"maximum":2130.74,"gross_charge":2608,"discounted_cash":597.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 561X-730","code_information":[{"code":"2781000907","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":365.12,"maximum":2130.74,"gross_charge":2608,"discounted_cash":597.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 4588X-5965","code_information":[{"code":"2781000908","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":6991.23,"maximum":10777.05,"gross_charge":13191,"discounted_cash":3020.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6991.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10777.05,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 4588X-5965","code_information":[{"code":"2781000908","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1846.74,"maximum":10777.05,"gross_charge":13191,"discounted_cash":3020.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2031.42,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2031.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2862.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2862.45,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6991.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10777.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1846.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1846.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1846.74,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 1234X-1605","code_information":[{"code":"2781002434","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3385.64,"maximum":5219,"gross_charge":6388,"discounted_cash":1462.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3385.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5219,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 1234X-1605","code_information":[{"code":"2781002434","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":894.32,"maximum":5219,"gross_charge":6388,"discounted_cash":1462.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":983.76,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":983.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1386.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1386.2,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3385.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5219,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 949X-1234","code_information":[{"code":"2781003180","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2094.42,"maximum":3228.56,"gross_charge":3951.72,"discounted_cash":904.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2094.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3228.56,"methodology":"fee schedule"}]}]},{"description":"CLOSURE IMPLNT 949X-1234","code_information":[{"code":"2781003180","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":553.25,"maximum":3228.56,"gross_charge":3951.72,"discounted_cash":904.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":608.57,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":608.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":857.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":857.53,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2094.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3228.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":553.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":553.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":553.25,"methodology":"fee schedule"}]}]},{"description":"OTHER SUPPLIES/DEVICES","code_information":[{"code":"279","type":"RC"}],"standard_charges":[{"minimum":207.62,"maximum":276.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"minimum":26052.99,"maximum":40434.86,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40434.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30326.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30326.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26052.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26313.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26834.58,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26574.05,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26052.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26052.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26052.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26704.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26052.99,"methodology":"case rate"}]}]},{"description":"HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS","code_information":[{"code":"2791","type":"APR-DRG"}],"standard_charges":[{"minimum":3209,"maximum":3209,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3209,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3209,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3209,"methodology":"case rate"}]}]},{"description":"HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS","code_information":[{"code":"2792","type":"APR-DRG"}],"standard_charges":[{"minimum":4070,"maximum":4070,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4070,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4070,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4070,"methodology":"case rate"}]}]},{"description":"HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS","code_information":[{"code":"2793","type":"APR-DRG"}],"standard_charges":[{"minimum":6494,"maximum":6494,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6494,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6494,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6494,"methodology":"case rate"}]}]},{"description":"HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS","code_information":[{"code":"2794","type":"APR-DRG"}],"standard_charges":[{"minimum":15300,"maximum":15300,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15300,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15300,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15300,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION DISCHARGED ALIVE WITH MCC","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":13966.28,"maximum":33645.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30636,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30636,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30515.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22887.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22887.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29641.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24443.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33645.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13966.28,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14105.95,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14385.27,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14245.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13966.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13966.28,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13966.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14315.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13966.28,"methodology":"case rate"}]}]},{"description":"ONCOLOGY - GENERAL","code_information":[{"code":"280","type":"RC"}],"standard_charges":[{"minimum":150.02,"maximum":965,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":199.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":945,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":791,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":965,"methodology":"case rate"}]}]},{"description":"ALCOHOLIC LIVER DISEASE","code_information":[{"code":"2801","type":"APR-DRG"}],"standard_charges":[{"minimum":3304,"maximum":3304,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3304,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3304,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3304,"methodology":"case rate"}]}]},{"description":"ALCOHOLIC LIVER DISEASE","code_information":[{"code":"2802","type":"APR-DRG"}],"standard_charges":[{"minimum":4312,"maximum":4312,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4312,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4312,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4312,"methodology":"case rate"}]}]},{"description":"ALCOHOLIC LIVER DISEASE","code_information":[{"code":"2803","type":"APR-DRG"}],"standard_charges":[{"minimum":6786,"maximum":6786,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6786,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6786,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6786,"methodology":"case rate"}]}]},{"description":"ALCOHOLIC LIVER DISEASE","code_information":[{"code":"2804","type":"APR-DRG"}],"standard_charges":[{"minimum":16195,"maximum":16195,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16195,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16195,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16195,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION DISCHARGED ALIVE WITH CC","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"minimum":8401.6,"maximum":24683.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18197,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18197,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24683.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18513.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18513.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17606.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14518.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19984.28,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8401.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8485.62,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8653.65,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8569.64,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8401.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8401.6,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8401.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8611.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8401.6,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS","code_information":[{"code":"2811","type":"APR-DRG"}],"standard_charges":[{"minimum":4483,"maximum":4483,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4483,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4483,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4483,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS","code_information":[{"code":"2812","type":"APR-DRG"}],"standard_charges":[{"minimum":5711,"maximum":5711,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5711,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5711,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5711,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS","code_information":[{"code":"2813","type":"APR-DRG"}],"standard_charges":[{"minimum":7509,"maximum":7509,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7509,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7509,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7509,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS","code_information":[{"code":"2814","type":"APR-DRG"}],"standard_charges":[{"minimum":12154,"maximum":12154,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12154,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12154,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12154,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION DISCHARGED ALIVE WITHOUT CC/MCC","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"minimum":6880.51,"maximum":36337.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13861,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13861,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36337.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27253.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27253.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13411.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11059.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15222.87,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6880.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6949.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7086.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7018.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6880.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6880.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6880.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7052.53,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6880.51,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY","code_information":[{"code":"2821","type":"APR-DRG"}],"standard_charges":[{"minimum":3285,"maximum":3285,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3285,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3285,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3285,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY","code_information":[{"code":"2822","type":"APR-DRG"}],"standard_charges":[{"minimum":4328,"maximum":4328,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4328,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4328,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4328,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY","code_information":[{"code":"2823","type":"APR-DRG"}],"standard_charges":[{"minimum":7138,"maximum":7138,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7138,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7138,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7138,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY","code_information":[{"code":"2824","type":"APR-DRG"}],"standard_charges":[{"minimum":18029,"maximum":18029,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18029,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18029,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18029,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION EXPIRED WITH MCC","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"minimum":16394.45,"maximum":37127.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33807,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33807,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27791.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20844.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20844.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32709.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26973.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37127.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16394.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16558.4,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16886.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16722.34,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16394.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16394.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16394.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16804.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16394.45,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE LIVER","code_information":[{"code":"2831","type":"APR-DRG"}],"standard_charges":[{"minimum":3539,"maximum":3539,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3539,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3539,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3539,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE LIVER","code_information":[{"code":"2832","type":"APR-DRG"}],"standard_charges":[{"minimum":4313,"maximum":4313,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4313,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4313,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4313,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE LIVER","code_information":[{"code":"2833","type":"APR-DRG"}],"standard_charges":[{"minimum":6364,"maximum":6364,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6364,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6364,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6364,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE LIVER","code_information":[{"code":"2834","type":"APR-DRG"}],"standard_charges":[{"minimum":13608,"maximum":13608,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13608,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13608,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13608,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION EXPIRED WITH CC","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"minimum":7003.47,"maximum":23984.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13624,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13624,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23984.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17988.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17988.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13182.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10870.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14962.93,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7003.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7073.51,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7213.58,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7143.54,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7003.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7003.47,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7003.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7178.56,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7003.47,"methodology":"case rate"}]}]},{"description":"DISORDERS OF GALLBLADDER AND BILIARY TRACT","code_information":[{"code":"2841","type":"APR-DRG"}],"standard_charges":[{"minimum":4200,"maximum":4200,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4200,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4200,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4200,"methodology":"case rate"}]}]},{"description":"DISORDERS OF GALLBLADDER AND BILIARY TRACT","code_information":[{"code":"2842","type":"APR-DRG"}],"standard_charges":[{"minimum":5371,"maximum":5371,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5371,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5371,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5371,"methodology":"case rate"}]}]},{"description":"DISORDERS OF GALLBLADDER AND BILIARY TRACT","code_information":[{"code":"2843","type":"APR-DRG"}],"standard_charges":[{"minimum":7731,"maximum":7731,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7731,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7731,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7731,"methodology":"case rate"}]}]},{"description":"DISORDERS OF GALLBLADDER AND BILIARY TRACT","code_information":[{"code":"2844","type":"APR-DRG"}],"standard_charges":[{"minimum":14724,"maximum":14724,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14724,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14724,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14724,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION EXPIRED WITHOUT CC/MCC","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"minimum":5614.62,"maximum":38707.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9726,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9726,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38707.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29031.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29031.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9411.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7760.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10682.21,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5614.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5670.77,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5783.06,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5726.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5614.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5614.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5614.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5754.99,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5614.62,"methodology":"case rate"}]}]},{"description":"CIRCULATORY DISORDERS EXCEPT AMI WITH CARDIAC CATHETERIZATION WITH MCC","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"minimum":18388.79,"maximum":45332.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41278,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41278,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26504.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19878.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19878.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39937.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32934.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45332.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18388.79,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18572.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18940.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18756.57,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18388.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18388.79,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18388.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18848.51,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18388.79,"methodology":"case rate"}]}]},{"description":"CIRCULATORY DISORDERS EXCEPT AMI WITH CARDIAC CATHETERIZATION WITHOUT MCC","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"minimum":9699.97,"maximum":47381.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21644,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21644,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47381.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35536.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35536.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20941.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17269.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23769.88,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9699.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9796.97,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9990.97,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9893.97,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9699.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9699.97,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9699.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9942.47,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9699.97,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"minimum":22396.04,"maximum":54822.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49919,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49919,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37517.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28138.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28138.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":48298.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39829.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54822.16,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22396.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22620.01,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23067.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22843.97,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22396.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22396.04,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22396.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22955.95,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22396.04,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITH CC","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"minimum":13465.95,"maximum":34324.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31254,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31254,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32083.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24063.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24063.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30239.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24937.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34324.19,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13465.95,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13600.61,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13869.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13735.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13465.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13465.95,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13465.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13802.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13465.95,"methodology":"case rate"}]}]},{"description":"ONCOLOGY TREATMENT","code_information":[{"code":"289","type":"RC"}],"standard_charges":[{"minimum":791,"maximum":965,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":945,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":791,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":965,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"minimum":8843.93,"maximum":25355.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18796,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18796,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25355.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19016.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19016.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18185.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14996.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20642.37,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8843.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8932.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9109.25,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9020.81,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8843.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8843.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8843.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9065.03,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8843.93,"methodology":"case rate"}]}]},{"description":"HEART FAILURE AND SHOCK WITH MCC","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":11363.34,"maximum":27763.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25280,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25280,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20416.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15312.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15312.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24459.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20170.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27763.85,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11363.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11476.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11704.25,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11590.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11363.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11363.34,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11363.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11647.43,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11363.34,"methodology":"case rate"}]}]},{"description":"HEART FAILURE AND SHOCK WITH CC","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"minimum":7932.98,"maximum":18680.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17009,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17009,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17658.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13243.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13243.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16457.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13571.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18680.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7932.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8012.31,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8170.97,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8091.64,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7932.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7932.98,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7932.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8131.31,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7932.98,"methodology":"case rate"}]}]},{"description":"HEART FAILURE AND SHOCK WITHOUT CC/MCC","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"minimum":5516.41,"maximum":27141.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12309,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12309,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27141.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20356.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20356.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11910.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9821.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13518.83,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5516.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5571.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5681.91,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5626.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5516.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5516.41,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5516.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5654.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5516.41,"methodology":"case rate"}]}]},{"description":"DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"minimum":10769.45,"maximum":26239.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23892,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23892,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20676.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15507.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15507.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23116.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19063.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26239.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10769.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10877.15,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11092.54,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10984.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10769.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10769.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10769.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11038.69,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10769.45,"methodology":"case rate"}]}]},{"description":"DURABLE MEDICAL EQUIPMENT (OTHER THAN RENAL) - SUPPLIES/DRUGS","code_information":[{"code":"294","type":"RC"}],"standard_charges":[{"minimum":17.79,"maximum":23.72,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"minimum":7380.84,"maximum":15955.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10838,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10838,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15955.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11966.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11966.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10486.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8648.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11903.51,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7380.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7454.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7602.27,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7528.46,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7380.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7380.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7380.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7565.37,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7380.84,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST UNEXPLAINED WITH MCC","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"minimum":13943.08,"maximum":32397.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29499,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29499,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24012.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18009.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18009.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28542.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23537.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32397.35,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13943.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14082.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14361.38,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14221.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13943.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13943.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13943.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14291.66,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13943.08,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST UNEXPLAINED WITH CC","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"minimum":6720.44,"maximum":18571.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13581,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13581,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18571.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13929.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13929.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13140.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10836.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14915.49,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6720.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6787.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6922.06,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6854.85,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6720.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6720.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6720.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6888.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6720.44,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST UNEXPLAINED WITHOUT CC/MCC","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"minimum":4688.97,"maximum":14113.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9452,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9452,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14113.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10585.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10585.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9145.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7541.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10381.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4688.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4735.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4829.64,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4782.75,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4688.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4688.97,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4688.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4806.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4688.97,"methodology":"case rate"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITH MCC","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"minimum":12008.17,"maximum":29907.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27232,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27232,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16010.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12008.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12008.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26348.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21728.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29907.31,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13782.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13920.06,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14195.7,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14057.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13782.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13782.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13782.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14126.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13782.23,"methodology":"case rate"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITH CC","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":8828.32,"maximum":21199.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19303,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19303,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11770.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8828.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8828.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18676.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15401.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21199.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9552.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9647.8,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9838.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9743.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9552.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9552.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9552.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9791.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9552.27,"methodology":"case rate"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"minimum":6790.04,"maximum":19052.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13634,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13634,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19052.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14289.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14289.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13191.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10878.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14973.25,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6857.95,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6993.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6925.85,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6959.8,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"}]}]},{"description":"ATHEROSCLEROSIS WITH MCC","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"minimum":10214.47,"maximum":22740.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20706,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20706,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13619.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10214.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10214.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20034.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16521.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22740.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10269.12,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10371.82,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10577.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10474.51,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10269.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10269.12,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10269.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10525.85,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10269.12,"methodology":"case rate"}]}]},{"description":"ATHEROSCLEROSIS WITHOUT MCC","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"minimum":6472.98,"maximum":25919.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12693,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12693,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25919.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19439.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19439.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12280.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10127.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13939.69,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6537.71,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6667.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6602.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6634.81,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.98,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK","code_information":[{"code":"3031","type":"APR-DRG"}],"standard_charges":[{"minimum":26272,"maximum":26272,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26272,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26272,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26272,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK","code_information":[{"code":"3032","type":"APR-DRG"}],"standard_charges":[{"minimum":33925,"maximum":33925,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33925,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33925,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33925,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK","code_information":[{"code":"3033","type":"APR-DRG"}],"standard_charges":[{"minimum":48514,"maximum":48514,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48514,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48514,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48514,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK","code_information":[{"code":"3034","type":"APR-DRG"}],"standard_charges":[{"minimum":63174,"maximum":63174,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63174,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63174,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63174,"methodology":"case rate"}]}]},{"description":"HYPERTENSION WITH MCC","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"minimum":10358.05,"maximum":22517.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20503,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20503,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17107.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12831.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12831.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19838.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16359.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22517.64,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10358.05,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10461.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10668.8,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10565.22,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10358.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10358.05,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10358.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10617.01,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10358.05,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK","code_information":[{"code":"3041","type":"APR-DRG"}],"standard_charges":[{"minimum":16310,"maximum":16310,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16310,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16310,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16310,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK","code_information":[{"code":"3042","type":"APR-DRG"}],"standard_charges":[{"minimum":20525,"maximum":20525,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20525,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20525,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20525,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK","code_information":[{"code":"3043","type":"APR-DRG"}],"standard_charges":[{"minimum":31305,"maximum":31305,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31305,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31305,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK","code_information":[{"code":"3044","type":"APR-DRG"}],"standard_charges":[{"minimum":45243,"maximum":45243,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45243,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45243,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45243,"methodology":"case rate"}]}]},{"description":"HYPERTENSION WITHOUT MCC","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"minimum":7078.48,"maximum":22679.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13741,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13741,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22679.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17010.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17010.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13295.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10963.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15090.84,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7078.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7149.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7290.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7220.05,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7078.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7078.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7078.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7255.45,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7078.48,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB EXCEPT TOES","code_information":[{"code":"3051","type":"APR-DRG"}],"standard_charges":[{"minimum":6407,"maximum":6407,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6407,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6407,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6407,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB EXCEPT TOES","code_information":[{"code":"3052","type":"APR-DRG"}],"standard_charges":[{"minimum":8785,"maximum":8785,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8785,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8785,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8785,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB EXCEPT TOES","code_information":[{"code":"3053","type":"APR-DRG"}],"standard_charges":[{"minimum":14213,"maximum":14213,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14213,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14213,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14213,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB EXCEPT TOES","code_information":[{"code":"3054","type":"APR-DRG"}],"standard_charges":[{"minimum":28335,"maximum":28335,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28335,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28335,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28335,"methodology":"case rate"}]}]},{"description":"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"minimum":12852.72,"maximum":29181.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26571,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26571,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17225.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12919.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12919.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25708.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21200.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29181.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12852.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12981.25,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13238.31,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13109.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12852.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12852.72,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12852.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13174.04,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12852.72,"methodology":"case rate"}]}]},{"description":"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"minimum":8437.17,"maximum":18199.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16572,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16572,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13470.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10102.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10102.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16033.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13222.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18199.78,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8437.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8521.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8690.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8605.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8437.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8437.17,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8437.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8648.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8437.17,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":8753.04,"maximum":24502.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22310,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22310,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11670.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8753.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8753.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21586.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17801.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24502.25,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10598.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10704.54,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10916.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10810.53,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10598.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10598.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10598.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10863.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10598.55,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR FRACTURE REPAIR","code_information":[{"code":"3081","type":"APR-DRG"}],"standard_charges":[{"minimum":7975,"maximum":7975,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7975,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7975,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7975,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR FRACTURE REPAIR","code_information":[{"code":"3082","type":"APR-DRG"}],"standard_charges":[{"minimum":9293,"maximum":9293,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9293,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9293,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9293,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR FRACTURE REPAIR","code_information":[{"code":"3083","type":"APR-DRG"}],"standard_charges":[{"minimum":12676,"maximum":12676,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12676,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12676,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12676,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR FRACTURE REPAIR","code_information":[{"code":"3084","type":"APR-DRG"}],"standard_charges":[{"minimum":18987,"maximum":18987,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18987,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18987,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18987,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":6990.32,"maximum":16557.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14207,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14207,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16557.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12418.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12418.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13745.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11335.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15602.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6990.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7060.23,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7200.03,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7130.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6990.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6990.32,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6990.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7165.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6990.32,"methodology":"case rate"}]}]},{"description":"OTHER SIGNIFICANT HIP AND FEMUR SURGERY","code_information":[{"code":"3091","type":"APR-DRG"}],"standard_charges":[{"minimum":8766,"maximum":8766,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8766,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8766,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8766,"methodology":"case rate"}]}]},{"description":"OTHER SIGNIFICANT HIP AND FEMUR SURGERY","code_information":[{"code":"3092","type":"APR-DRG"}],"standard_charges":[{"minimum":11585,"maximum":11585,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11585,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11585,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11585,"methodology":"case rate"}]}]},{"description":"OTHER SIGNIFICANT HIP AND FEMUR SURGERY","code_information":[{"code":"3093","type":"APR-DRG"}],"standard_charges":[{"minimum":17033,"maximum":17033,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17033,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17033,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17033,"methodology":"case rate"}]}]},{"description":"OTHER SIGNIFICANT HIP AND FEMUR SURGERY","code_information":[{"code":"3094","type":"APR-DRG"}],"standard_charges":[{"minimum":27792,"maximum":27792,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27792,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27792,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27792,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":5599.92,"maximum":12964.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10506,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10506,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12964.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9723.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9723.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10165.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8382.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11538.35,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5599.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5655.92,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5767.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5711.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5599.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5599.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5599.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5739.92,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5599.92,"methodology":"case rate"}]}]},{"description":"INTERVERTEBRAL DISC EXCISION AND DECOMPRESSION","code_information":[{"code":"3101","type":"APR-DRG"}],"standard_charges":[{"minimum":7052,"maximum":7052,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7052,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7052,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7052,"methodology":"case rate"}]}]},{"description":"RL-A-PRION PROT DETECT3001255C","code_information":[{"code":"3101002344","type":"CDM"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":453.58,"maximum":699.19,"gross_charge":855.8,"discounted_cash":195.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":453.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":699.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-PRION PROT DETECT3001255C","code_information":[{"code":"3101002344","type":"CDM"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":453.58,"maximum":699.19,"gross_charge":855.8,"discounted_cash":195.98,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":453.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":699.19,"methodology":"fee schedule"}]}]},{"description":"INTERVERTEBRAL DISC EXCISION AND DECOMPRESSION","code_information":[{"code":"3102","type":"APR-DRG"}],"standard_charges":[{"minimum":9047,"maximum":9047,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9047,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9047,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9047,"methodology":"case rate"}]}]},{"description":"INTERVERTEBRAL DISC EXCISION AND DECOMPRESSION","code_information":[{"code":"3103","type":"APR-DRG"}],"standard_charges":[{"minimum":12912,"maximum":12912,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12912,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12912,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12912,"methodology":"case rate"}]}]},{"description":"INTERVERTEBRAL DISC EXCISION AND DECOMPRESSION","code_information":[{"code":"3104","type":"APR-DRG"}],"standard_charges":[{"minimum":25507,"maximum":25507,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25507,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25507,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25507,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"minimum":6673.27,"maximum":30138.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12867,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12867,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30138.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22604.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22604.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12449.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10266.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14131.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6673.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6740.01,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6873.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6806.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6673.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6673.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6673.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6840.11,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6673.27,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"minimum":8011.08,"maximum":22631.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15339,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15339,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22631.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16973.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16973.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14841.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12239.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16846.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8011.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8091.2,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8251.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8171.31,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8011.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8011.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8011.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8211.36,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8011.08,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3121","type":"APR-DRG"}],"standard_charges":[{"minimum":8265,"maximum":8265,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8265,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8265,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8265,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3122","type":"APR-DRG"}],"standard_charges":[{"minimum":13981,"maximum":13981,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13981,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13981,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13981,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3123","type":"APR-DRG"}],"standard_charges":[{"minimum":23761,"maximum":23761,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23761,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23761,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23761,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3124","type":"APR-DRG"}],"standard_charges":[{"minimum":44792,"maximum":44792,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44792,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44792,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44792,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"minimum":6790.04,"maximum":17526.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13436,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13436,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17526.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13145.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13145.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13000.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10720.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14756.63,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6857.95,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6993.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6925.85,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6959.8,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.04,"methodology":"case rate"}]}]},{"description":"KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT","code_information":[{"code":"3131","type":"APR-DRG"}],"standard_charges":[{"minimum":7729,"maximum":7729,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7729,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7729,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7729,"methodology":"case rate"}]}]},{"description":"KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT","code_information":[{"code":"3132","type":"APR-DRG"}],"standard_charges":[{"minimum":10472,"maximum":10472,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10472,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10472,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10472,"methodology":"case rate"}]}]},{"description":"KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT","code_information":[{"code":"3133","type":"APR-DRG"}],"standard_charges":[{"minimum":16378,"maximum":16378,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16378,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16378,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16378,"methodology":"case rate"}]}]},{"description":"KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT","code_information":[{"code":"3134","type":"APR-DRG"}],"standard_charges":[{"minimum":26704,"maximum":26704,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26704,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26704,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26704,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"minimum":17926.36,"maximum":79821.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38124,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38124,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79821.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59866.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59866.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":36886.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30418.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41868.58,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17926.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18105.63,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18464.16,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18284.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17926.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17926.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17926.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18374.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17926.36,"methodology":"case rate"}]}]},{"description":"FOOT AND TOE PROCEDURES","code_information":[{"code":"3141","type":"APR-DRG"}],"standard_charges":[{"minimum":6910,"maximum":6910,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6910,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6910,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6910,"methodology":"case rate"}]}]},{"description":"FOOT AND TOE PROCEDURES","code_information":[{"code":"3142","type":"APR-DRG"}],"standard_charges":[{"minimum":7463,"maximum":7463,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7463,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7463,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7463,"methodology":"case rate"}]}]},{"description":"FOOT AND TOE PROCEDURES","code_information":[{"code":"3143","type":"APR-DRG"}],"standard_charges":[{"minimum":10512,"maximum":10512,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10512,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10512,"methodology":"case rate"}]}]},{"description":"FOOT AND TOE PROCEDURES","code_information":[{"code":"3144","type":"APR-DRG"}],"standard_charges":[{"minimum":20276,"maximum":20276,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20276,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20276,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"minimum":8714.78,"maximum":47201.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18228,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18228,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47201.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35401.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35401.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17637.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14544.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20019.35,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8714.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8801.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8976.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8889.08,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8714.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8714.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8714.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8932.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8714.78,"methodology":"case rate"}]}]},{"description":"SHOULDER UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT","code_information":[{"code":"3151","type":"APR-DRG"}],"standard_charges":[{"minimum":6444,"maximum":6444,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6444,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6444,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6444,"methodology":"case rate"}]}]},{"description":"SHOULDER UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT","code_information":[{"code":"3152","type":"APR-DRG"}],"standard_charges":[{"minimum":9572,"maximum":9572,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9572,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9572,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9572,"methodology":"case rate"}]}]},{"description":"SHOULDER UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT","code_information":[{"code":"3153","type":"APR-DRG"}],"standard_charges":[{"minimum":14716,"maximum":14716,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14716,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14716,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14716,"methodology":"case rate"}]}]},{"description":"SHOULDER UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT","code_information":[{"code":"3154","type":"APR-DRG"}],"standard_charges":[{"minimum":27705,"maximum":27705,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27705,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27705,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27705,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"minimum":6552.63,"maximum":124374.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13942,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13942,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124374.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":93282.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":93282.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13489.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11124.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15311.58,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6552.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6618.16,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6749.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6683.69,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6552.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6552.63,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6552.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6716.45,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6552.63,"methodology":"case rate"}]}]},{"description":"HAND AND WRIST PROCEDURES","code_information":[{"code":"3161","type":"APR-DRG"}],"standard_charges":[{"minimum":5527,"maximum":5527,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5527,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5527,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5527,"methodology":"case rate"}]}]},{"description":"HAND AND WRIST PROCEDURES","code_information":[{"code":"3162","type":"APR-DRG"}],"standard_charges":[{"minimum":7360,"maximum":7360,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7360,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7360,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7360,"methodology":"case rate"}]}]},{"description":"HAND AND WRIST PROCEDURES","code_information":[{"code":"3163","type":"APR-DRG"}],"standard_charges":[{"minimum":11759,"maximum":11759,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11759,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11759,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11759,"methodology":"case rate"}]}]},{"description":"HAND AND WRIST PROCEDURES","code_information":[{"code":"3164","type":"APR-DRG"}],"standard_charges":[{"minimum":22177,"maximum":22177,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22177,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22177,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22177,"methodology":"case rate"}]}]},{"description":"CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"minimum":49112.85,"maximum":72051.1,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72051.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54039.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54039.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":49112.85,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49603.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50586.24,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":50095.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":49112.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":49112.85,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":49112.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50340.68,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":49112.85,"methodology":"case rate"}]}]},{"description":"TENDON MUSCLE AND OTHER SOFT TISSUE PROCEDURES","code_information":[{"code":"3171","type":"APR-DRG"}],"standard_charges":[{"minimum":6061,"maximum":6061,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6061,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6061,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6061,"methodology":"case rate"}]}]},{"description":"TENDON MUSCLE AND OTHER SOFT TISSUE PROCEDURES","code_information":[{"code":"3172","type":"APR-DRG"}],"standard_charges":[{"minimum":8371,"maximum":8371,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8371,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8371,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8371,"methodology":"case rate"}]}]},{"description":"TENDON MUSCLE AND OTHER SOFT TISSUE PROCEDURES","code_information":[{"code":"3173","type":"APR-DRG"}],"standard_charges":[{"minimum":13579,"maximum":13579,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13579,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13579,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13579,"methodology":"case rate"}]}]},{"description":"TENDON MUSCLE AND OTHER SOFT TISSUE PROCEDURES","code_information":[{"code":"3174","type":"APR-DRG"}],"standard_charges":[{"minimum":26488,"maximum":26488,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26488,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26488,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26488,"methodology":"case rate"}]}]},{"description":"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"minimum":35242.91,"maximum":84597.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77031,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77031,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80738.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60554.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60554.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":74530.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":61461.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":84597.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35242.91,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35595.34,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36300.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35947.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35242.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35242.91,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35242.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36123.99,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35242.91,"methodology":"case rate"}]}]},{"description":"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"minimum":19173.69,"maximum":64059.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44101,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44101,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64059.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48045.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48045.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":42669.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":35187.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":48433.05,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19173.69,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19365.43,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19748.91,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19557.17,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19173.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19173.69,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19173.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19653.04,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19173.69,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES","code_information":[{"code":"3201","type":"APR-DRG"}],"standard_charges":[{"minimum":6535,"maximum":6535,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6535,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES","code_information":[{"code":"3202","type":"APR-DRG"}],"standard_charges":[{"minimum":9470,"maximum":9470,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9470,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9470,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9470,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES","code_information":[{"code":"3203","type":"APR-DRG"}],"standard_charges":[{"minimum":14692,"maximum":14692,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14692,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14692,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14692,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES","code_information":[{"code":"3204","type":"APR-DRG"}],"standard_charges":[{"minimum":24320,"maximum":24320,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24320,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24320,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24320,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"minimum":23287.66,"maximum":69455.35,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69455.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52092.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52092.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23287.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23520.54,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23986.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23753.42,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23287.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23287.66,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23287.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23869.86,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23287.66,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION AND OTHER BACK OR NECK PROCEDURES EXCEPT DISC EXCISION OR DECOMPRESSION","code_information":[{"code":"3211","type":"APR-DRG"}],"standard_charges":[{"minimum":10325,"maximum":10325,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10325,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10325,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10325,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION AND OTHER BACK OR NECK PROCEDURES EXCEPT DISC EXCISION OR DECOMPRESSION","code_information":[{"code":"3212","type":"APR-DRG"}],"standard_charges":[{"minimum":13030,"maximum":13030,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13030,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13030,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13030,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION AND OTHER BACK OR NECK PROCEDURES EXCEPT DISC EXCISION OR DECOMPRESSION","code_information":[{"code":"3213","type":"APR-DRG"}],"standard_charges":[{"minimum":20188,"maximum":20188,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20188,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20188,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20188,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION AND OTHER BACK OR NECK PROCEDURES EXCEPT DISC EXCISION OR DECOMPRESSION","code_information":[{"code":"3214","type":"APR-DRG"}],"standard_charges":[{"minimum":34052,"maximum":34052,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34052,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34052,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34052,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"minimum":15263.88,"maximum":49862.63,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49862.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37397.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37397.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15263.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15416.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15721.8,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15569.16,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15263.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15263.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15263.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15645.48,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15263.88,"methodology":"case rate"}]}]},{"description":"SHOULDER AND ELBOW JOINT REPLACEMENT","code_information":[{"code":"3221","type":"APR-DRG"}],"standard_charges":[{"minimum":9556,"maximum":9556,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9556,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9556,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9556,"methodology":"case rate"}]}]},{"description":"SHOULDER AND ELBOW JOINT REPLACEMENT","code_information":[{"code":"3222","type":"APR-DRG"}],"standard_charges":[{"minimum":10837,"maximum":10837,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10837,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10837,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10837,"methodology":"case rate"}]}]},{"description":"SHOULDER AND ELBOW JOINT REPLACEMENT","code_information":[{"code":"3223","type":"APR-DRG"}],"standard_charges":[{"minimum":15066,"maximum":15066,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15066,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15066,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15066,"methodology":"case rate"}]}]},{"description":"SHOULDER AND ELBOW JOINT REPLACEMENT","code_information":[{"code":"3224","type":"APR-DRG"}],"standard_charges":[{"minimum":25225,"maximum":25225,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25225,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25225,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25225,"methodology":"case rate"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"minimum":33589.65,"maximum":44785.34,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44785.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33589.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33589.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34211.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34553.44,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35237.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34895.55,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34211.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34211.32,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34211.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35066.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34211.32,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT","code_information":[{"code":"3231","type":"APR-DRG"}],"standard_charges":[{"minimum":9406,"maximum":9406,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9406,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9406,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9406,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT","code_information":[{"code":"3232","type":"APR-DRG"}],"standard_charges":[{"minimum":10671,"maximum":10671,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10671,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10671,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10671,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT","code_information":[{"code":"3233","type":"APR-DRG"}],"standard_charges":[{"minimum":14453,"maximum":14453,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14453,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14453,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14453,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT","code_information":[{"code":"3234","type":"APR-DRG"}],"standard_charges":[{"minimum":21763,"maximum":21763,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21763,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21763,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21763,"methodology":"case rate"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"minimum":25981.07,"maximum":103068.58,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103068.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77302.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77302.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25981.07,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26240.89,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26760.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26500.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25981.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25981.07,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25981.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26630.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25981.07,"methodology":"case rate"}]}]},{"description":"ELECTIVE HIP JOINT REPLACEMENT","code_information":[{"code":"3241","type":"APR-DRG"}],"standard_charges":[{"minimum":8192,"maximum":8192,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8192,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8192,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8192,"methodology":"case rate"}]}]},{"description":"ELECTIVE HIP JOINT REPLACEMENT","code_information":[{"code":"3242","type":"APR-DRG"}],"standard_charges":[{"minimum":9120,"maximum":9120,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9120,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9120,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9120,"methodology":"case rate"}]}]},{"description":"ELECTIVE HIP JOINT REPLACEMENT","code_information":[{"code":"3243","type":"APR-DRG"}],"standard_charges":[{"minimum":13108,"maximum":13108,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13108,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13108,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13108,"methodology":"case rate"}]}]},{"description":"ELECTIVE HIP JOINT REPLACEMENT","code_information":[{"code":"3244","type":"APR-DRG"}],"standard_charges":[{"minimum":21961,"maximum":21961,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21961,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21961,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21961,"methodology":"case rate"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"minimum":23405.97,"maximum":65720.93,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65720.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49291.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49291.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23405.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23640.03,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24108.15,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23874.09,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23405.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23405.97,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23405.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23991.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23405.97,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT","code_information":[{"code":"3251","type":"APR-DRG"}],"standard_charges":[{"minimum":12104,"maximum":12104,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12104,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12104,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12104,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT","code_information":[{"code":"3252","type":"APR-DRG"}],"standard_charges":[{"minimum":14750,"maximum":14750,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14750,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14750,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14750,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT","code_information":[{"code":"3253","type":"APR-DRG"}],"standard_charges":[{"minimum":18845,"maximum":18845,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18845,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18845,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18845,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT","code_information":[{"code":"3254","type":"APR-DRG"}],"standard_charges":[{"minimum":27432,"maximum":27432,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27432,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27432,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27432,"methodology":"case rate"}]}]},{"description":"STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"minimum":26959.98,"maximum":108730.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99006,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99006,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35945.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26959.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26959.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":95791.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":78994.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":108730.41,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":40549.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":40954.8,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41765.78,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":41360.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":40549.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":40549.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":40549.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":41563.04,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":40549.3,"methodology":"case rate"}]}]},{"description":"ELECTIVE KNEE JOINT REPLACEMENT","code_information":[{"code":"3261","type":"APR-DRG"}],"standard_charges":[{"minimum":7955,"maximum":7955,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7955,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7955,"methodology":"case rate"}]}]},{"description":"ELECTIVE KNEE JOINT REPLACEMENT","code_information":[{"code":"3262","type":"APR-DRG"}],"standard_charges":[{"minimum":8708,"maximum":8708,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8708,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8708,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8708,"methodology":"case rate"}]}]},{"description":"ELECTIVE KNEE JOINT REPLACEMENT","code_information":[{"code":"3263","type":"APR-DRG"}],"standard_charges":[{"minimum":12256,"maximum":12256,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12256,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12256,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12256,"methodology":"case rate"}]}]},{"description":"ELECTIVE KNEE JOINT REPLACEMENT","code_information":[{"code":"3264","type":"APR-DRG"}],"standard_charges":[{"minimum":18428,"maximum":18428,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18428,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18428,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18428,"methodology":"case rate"}]}]},{"description":"STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"minimum":20049.84,"maximum":92045.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48331,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48331,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92045.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":69035.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":69035.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":46762.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38562.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":53078.92,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20049.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20250.34,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20651.34,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20450.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20049.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20049.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20049.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20551.09,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20049.84,"methodology":"case rate"}]}]},{"description":"STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"minimum":13595.87,"maximum":59106.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29586,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29586,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59106.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44331.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44331.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28625.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23606.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32492.25,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13595.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13731.83,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14003.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13867.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13595.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13595.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13595.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13935.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13595.87,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"minimum":28213.75,"maximum":101235.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92181,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92181,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37617.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28213.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28213.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":89188.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":73549.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":101235.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":36782.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":37150.38,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":37886.03,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":37518.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":36782.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":36782.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":36782.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":37702.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":36782.55,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"minimum":19551.84,"maximum":69600.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47465,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47465,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69600.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52201.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52201.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45924.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37871.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52127.88,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19551.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19747.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20138.4,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19942.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19551.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19551.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19551.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20040.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19551.84,"methodology":"case rate"}]}]},{"description":"RADIATION THERAPY","code_information":[{"code":"330","type":"RC"}],"standard_charges":[{"minimum":2549,"maximum":12660,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2568,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12660,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2549,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY ADMINISTRATION","code_information":[{"code":"331","type":"RC"}],"standard_charges":[{"minimum":615,"maximum":744,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":736,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":615,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":744,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"minimum":14040.51,"maximum":47277.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31731,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31731,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47277.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35458.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35458.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30701.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25317.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34848.19,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14040.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14180.92,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14461.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14321.33,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14040.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14040.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14040.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14391.53,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14040.51,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY ADMINISTRATION","code_information":[{"code":"332","type":"RC"}],"standard_charges":[{"minimum":615,"maximum":744,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":736,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":615,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":744,"methodology":"case rate"}]}]},{"description":"RECTAL RESECTION WITH MCC","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"minimum":25919.06,"maximum":72037.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65595,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65595,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34558.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25919.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25919.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":63465.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":52336.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":72037.89,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28096.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28377.79,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28939.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28658.76,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28096.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28096.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28096.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28799.25,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28096.82,"methodology":"case rate"}]}]},{"description":"RADIATION THERAPY","code_information":[{"code":"333","type":"RC"}],"standard_charges":[{"minimum":2549,"maximum":12660,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2568,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12660,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2549,"methodology":"case rate"}]}]},{"description":"RECTAL RESECTION WITH CC","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"minimum":17708.29,"maximum":68282.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42514,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42514,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68282.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":51212.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":51212.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":41133.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":33920.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46689.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17708.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17885.38,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18239.54,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18062.46,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17708.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17708.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17708.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18151,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17708.29,"methodology":"case rate"}]}]},{"description":"RECTAL RESECTION WITHOUT CC/MCC","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"minimum":14099.29,"maximum":48637.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28934,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28934,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48637.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36478.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36478.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27994.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23086.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31776.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14099.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14240.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14522.27,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14381.28,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14099.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14099.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14099.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14451.78,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14099.29,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY ADMINISTRATION","code_information":[{"code":"335","type":"RC"}],"standard_charges":[{"minimum":615,"maximum":744,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":736,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":615,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":744,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITH MCC","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"minimum":25739.95,"maximum":83450.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75987,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75987,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34319.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25739.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25739.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":73519.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":60627.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":83450.41,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29293.12,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29586.06,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30171.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29878.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29293.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29293.12,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29293.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30025.45,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29293.12,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITH CC","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"minimum":17607.76,"maximum":58009.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42570,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42570,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58009.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43508.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43508.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":41188.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":33965.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46751.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17607.76,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17783.84,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18136,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17959.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17607.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17607.76,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17607.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18047.96,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17607.76,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"minimum":13144.26,"maximum":39265.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30801,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30801,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39265.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29449.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29449.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29801.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24575.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33827.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13144.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13275.71,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13538.59,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13407.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13144.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13144.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13144.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13472.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13144.26,"methodology":"case rate"}]}]},{"description":"RADIATION THERAPY","code_information":[{"code":"339","type":"RC"}],"standard_charges":[{"minimum":2549,"maximum":12660,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2568,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12660,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2549,"methodology":"case rate"}]}]},{"description":"FRACTURE OF FEMUR","code_information":[{"code":"3401","type":"APR-DRG"}],"standard_charges":[{"minimum":2989,"maximum":2989,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2989,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2989,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2989,"methodology":"case rate"}]}]},{"description":"FRACTURE OF FEMUR","code_information":[{"code":"3402","type":"APR-DRG"}],"standard_charges":[{"minimum":3648,"maximum":3648,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3648,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3648,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3648,"methodology":"case rate"}]}]},{"description":"FRACTURE OF FEMUR","code_information":[{"code":"3403","type":"APR-DRG"}],"standard_charges":[{"minimum":5368,"maximum":5368,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5368,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5368,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5368,"methodology":"case rate"}]}]},{"description":"FRACTURE OF FEMUR","code_information":[{"code":"3404","type":"APR-DRG"}],"standard_charges":[{"minimum":9798,"maximum":9798,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9798,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9798,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9798,"methodology":"case rate"}]}]},{"description":"FRACTURE OF PELVIS OR DISLOCATION OF HIP","code_information":[{"code":"3411","type":"APR-DRG"}],"standard_charges":[{"minimum":3095,"maximum":3095,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3095,"methodology":"case rate"}]}]},{"description":"FRACTURE OF PELVIS OR DISLOCATION OF HIP","code_information":[{"code":"3412","type":"APR-DRG"}],"standard_charges":[{"minimum":3702,"maximum":3702,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3702,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3702,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3702,"methodology":"case rate"}]}]},{"description":"FRACTURE OF PELVIS OR DISLOCATION OF HIP","code_information":[{"code":"3413","type":"APR-DRG"}],"standard_charges":[{"minimum":4975,"maximum":4975,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4975,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4975,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4975,"methodology":"case rate"}]}]},{"description":"FRACTURE OF PELVIS OR DISLOCATION OF HIP","code_information":[{"code":"3414","type":"APR-DRG"}],"standard_charges":[{"minimum":10418,"maximum":10418,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10418,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10418,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10418,"methodology":"case rate"}]}]},{"description":"FRACTURES AND DISLOCATIONS EXCEPT FEMUR PELVIS AND BACK","code_information":[{"code":"3421","type":"APR-DRG"}],"standard_charges":[{"minimum":3463,"maximum":3463,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3463,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3463,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3463,"methodology":"case rate"}]}]},{"description":"FRACTURES AND DISLOCATIONS EXCEPT FEMUR PELVIS AND BACK","code_information":[{"code":"3422","type":"APR-DRG"}],"standard_charges":[{"minimum":4362,"maximum":4362,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4362,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4362,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4362,"methodology":"case rate"}]}]},{"description":"FRACTURES AND DISLOCATIONS EXCEPT FEMUR PELVIS AND BACK","code_information":[{"code":"3423","type":"APR-DRG"}],"standard_charges":[{"minimum":6127,"maximum":6127,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6127,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6127,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6127,"methodology":"case rate"}]}]},{"description":"FRACTURES AND DISLOCATIONS EXCEPT FEMUR PELVIS AND BACK","code_information":[{"code":"3424","type":"APR-DRG"}],"standard_charges":[{"minimum":12025,"maximum":12025,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12025,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12025,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12025,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY","code_information":[{"code":"3431","type":"APR-DRG"}],"standard_charges":[{"minimum":5339,"maximum":5339,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5339,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5339,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY","code_information":[{"code":"3432","type":"APR-DRG"}],"standard_charges":[{"minimum":6308,"maximum":6308,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6308,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6308,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6308,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY","code_information":[{"code":"3433","type":"APR-DRG"}],"standard_charges":[{"minimum":9588,"maximum":9588,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9588,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9588,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY","code_information":[{"code":"3434","type":"APR-DRG"}],"standard_charges":[{"minimum":16865,"maximum":16865,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16865,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16865,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16865,"methodology":"case rate"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"minimum":21820.29,"maximum":61788.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56262,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56262,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29093.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21820.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21820.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":54435.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":44890.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61788.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22109.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22331.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22773.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22552.12,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22109.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22109.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22109.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22662.67,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22109.92,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS","code_information":[{"code":"3441","type":"APR-DRG"}],"standard_charges":[{"minimum":4650,"maximum":4650,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4650,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4650,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4650,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS","code_information":[{"code":"3442","type":"APR-DRG"}],"standard_charges":[{"minimum":5840,"maximum":5840,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5840,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5840,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5840,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS","code_information":[{"code":"3443","type":"APR-DRG"}],"standard_charges":[{"minimum":8637,"maximum":8637,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8637,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8637,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8637,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS","code_information":[{"code":"3444","type":"APR-DRG"}],"standard_charges":[{"minimum":15107,"maximum":15107,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15107,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15107,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15107,"methodology":"case rate"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"minimum":12785.45,"maximum":33893.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30681,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30681,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33893.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25420.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25420.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29685.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24479.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33694.97,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12785.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12913.31,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13169.02,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13041.16,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12785.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12785.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12785.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13105.09,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12785.45,"methodology":"case rate"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"minimum":10903.23,"maximum":26462.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24095,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24095,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24531.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18399.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18399.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23313.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19225.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26462.1,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10903.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11012.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11230.33,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11121.3,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10903.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10903.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10903.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11175.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10903.23,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS","code_information":[{"code":"3461","type":"APR-DRG"}],"standard_charges":[{"minimum":4172,"maximum":4172,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4172,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4172,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4172,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS","code_information":[{"code":"3462","type":"APR-DRG"}],"standard_charges":[{"minimum":5689,"maximum":5689,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5689,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5689,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5689,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS","code_information":[{"code":"3463","type":"APR-DRG"}],"standard_charges":[{"minimum":9471,"maximum":9471,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9471,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9471,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9471,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS","code_information":[{"code":"3464","type":"APR-DRG"}],"standard_charges":[{"minimum":21739,"maximum":21739,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21739,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21739,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21739,"methodology":"case rate"}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITH MCC","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"minimum":12420.9,"maximum":54388.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49524,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49524,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16560.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12420.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12420.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":47916.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39514.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54388.93,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19575.81,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19771.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20163.09,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19967.33,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19575.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19575.81,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19575.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20065.21,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19575.81,"methodology":"case rate"}]}]},{"description":"OTHER BACK AND NECK DISORDERS FRACTURES AND INJURIES","code_information":[{"code":"3471","type":"APR-DRG"}],"standard_charges":[{"minimum":4107,"maximum":4107,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4107,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4107,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4107,"methodology":"case rate"}]}]},{"description":"OTHER BACK AND NECK DISORDERS FRACTURES AND INJURIES","code_information":[{"code":"3472","type":"APR-DRG"}],"standard_charges":[{"minimum":5033,"maximum":5033,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5033,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5033,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5033,"methodology":"case rate"}]}]},{"description":"OTHER BACK AND NECK DISORDERS FRACTURES AND INJURIES","code_information":[{"code":"3473","type":"APR-DRG"}],"standard_charges":[{"minimum":6736,"maximum":6736,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6736,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6736,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6736,"methodology":"case rate"}]}]},{"description":"OTHER BACK AND NECK DISORDERS FRACTURES AND INJURIES","code_information":[{"code":"3474","type":"APR-DRG"}],"standard_charges":[{"minimum":13223,"maximum":13223,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13223,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13223,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13223,"methodology":"case rate"}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITH CC","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"minimum":11008.4,"maximum":40552.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26473,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26473,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40552.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30414.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30414.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25614.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21122.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29073.85,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11008.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11118.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11338.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11228.57,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11008.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11008.4,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11008.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11283.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11008.4,"methodology":"case rate"}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"minimum":8085.32,"maximum":27542.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18426,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18426,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27542.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20657.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20657.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17827.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14701.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20235.96,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8085.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8166.18,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8327.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8247.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8085.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8085.32,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8085.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8287.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8085.32,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE","code_information":[{"code":"3491","type":"APR-DRG"}],"standard_charges":[{"minimum":3464,"maximum":3464,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3464,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3464,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3464,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE","code_information":[{"code":"3492","type":"APR-DRG"}],"standard_charges":[{"minimum":5165,"maximum":5165,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5165,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5165,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5165,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE","code_information":[{"code":"3493","type":"APR-DRG"}],"standard_charges":[{"minimum":7719,"maximum":7719,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7719,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7719,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7719,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE","code_information":[{"code":"3494","type":"APR-DRG"}],"standard_charges":[{"minimum":14218,"maximum":14218,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14218,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14218,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14218,"methodology":"case rate"}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"minimum":14879.13,"maximum":50322.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45822,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45822,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19838.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14879.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14879.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":44334.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36560.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50322.75,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19977.15,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20176.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20576.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20376.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19977.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19977.15,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19977.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20476.58,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19977.15,"methodology":"case rate"}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"minimum":12907.63,"maximum":47097.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27394,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27394,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47097.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35323.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35323.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26504.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21857,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30084.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12907.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13036.71,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13294.86,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13165.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12907.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12907.63,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12907.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13230.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12907.63,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3511","type":"APR-DRG"}],"standard_charges":[{"minimum":3399,"maximum":3399,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3399,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3399,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3399,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3512","type":"APR-DRG"}],"standard_charges":[{"minimum":3966,"maximum":3966,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3966,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3966,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3966,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3513","type":"APR-DRG"}],"standard_charges":[{"minimum":6184,"maximum":6184,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6184,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6184,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6184,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3514","type":"APR-DRG"}],"standard_charges":[{"minimum":11755,"maximum":11755,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11755,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11755,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11755,"methodology":"case rate"}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"minimum":9799.73,"maximum":32792.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20227,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20227,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32792.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24595.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24595.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19570.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16139.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22214.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9799.73,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9897.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10093.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9995.73,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9799.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9799.73,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9799.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10044.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9799.73,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"minimum":17708.55,"maximum":61207.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55733,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55733,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23610.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17708.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17708.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":53923.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":44467.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61207.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23954.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24193.79,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24672.87,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24433.33,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23954.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23954.24,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23954.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24553.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23954.24,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"minimum":14427.94,"maximum":68025.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32349,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32349,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68025.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":51020.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":51020.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31299.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25810.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35526.92,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14427.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14572.22,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14860.78,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14716.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14427.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14427.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14427.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14788.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14427.94,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"minimum":11582.96,"maximum":50222.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25780,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25780,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50222.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37667.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37667.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24943.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20569.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28312.61,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11582.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11698.79,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11930.45,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11814.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11582.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11582.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11582.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11872.54,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11582.96,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"minimum":26170.86,"maximum":84112.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76590,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76590,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34893.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26170.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26170.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":74103.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":61109.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":84112.63,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34260.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34602.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35287.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34945.25,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34260.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34260.04,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34260.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35116.55,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34260.04,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"minimum":18688.06,"maximum":99282.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42273,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42273,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99282.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74463.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74463.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":40901.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":33728.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46425.75,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18688.06,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18874.95,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19248.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19061.83,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18688.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18688.06,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18688.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19155.27,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18688.06,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"minimum":11752.31,"maximum":69541.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25767,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25767,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69541.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52157.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52157.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24930.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20559.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28298.17,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11752.31,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11869.84,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12104.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11987.36,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11752.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11752.31,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11752.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12046.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11752.31,"methodology":"case rate"}]}]},{"description":"SURGERY LEVEL 1 1ST 30MIN","code_information":[{"code":"3601000677","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2401.96,"maximum":3702.65,"gross_charge":4532,"discounted_cash":1037.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2401.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3702.65,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 1 1ST 30MIN","code_information":[{"code":"3601000677","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2401.96,"maximum":3702.65,"gross_charge":4532,"discounted_cash":1037.83,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2401.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3702.65,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 1 ADD 15MIN","code_information":[{"code":"3601000678","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":758.43,"maximum":1169.13,"gross_charge":1431,"discounted_cash":327.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":758.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1169.13,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 1 ADD 15MIN","code_information":[{"code":"3601000678","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":758.43,"maximum":1169.13,"gross_charge":1431,"discounted_cash":327.7,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":758.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1169.13,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 2 1ST 30MIN","code_information":[{"code":"3601000679","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3474.68,"maximum":5356.26,"gross_charge":6556,"discounted_cash":1501.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3474.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5356.26,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 2 1ST 30MIN","code_information":[{"code":"3601000679","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3474.68,"maximum":5356.26,"gross_charge":6556,"discounted_cash":1501.33,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3474.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5356.26,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 2 ADD 15MIN","code_information":[{"code":"3601000680","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1624.45,"maximum":2504.11,"gross_charge":3065,"discounted_cash":701.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1624.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2504.11,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 2 ADD 15MIN","code_information":[{"code":"3601000680","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1624.45,"maximum":2504.11,"gross_charge":3065,"discounted_cash":701.89,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1624.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2504.11,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 3 1ST 30MIN","code_information":[{"code":"3601000681","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":4314.2,"maximum":6650.38,"gross_charge":8140,"discounted_cash":1864.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4314.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6650.38,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 3 1ST 30MIN","code_information":[{"code":"3601000681","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":4314.2,"maximum":6650.38,"gross_charge":8140,"discounted_cash":1864.06,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4314.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6650.38,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 3 ADD 15MIN","code_information":[{"code":"3601000682","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1966.3,"maximum":3031.07,"gross_charge":3710,"discounted_cash":849.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1966.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3031.07,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 3 ADD 15MIN","code_information":[{"code":"3601000682","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1966.3,"maximum":3031.07,"gross_charge":3710,"discounted_cash":849.59,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1966.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3031.07,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 4 1ST 30MIN","code_information":[{"code":"3601000683","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":4921.05,"maximum":7585.85,"gross_charge":9285,"discounted_cash":2126.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4921.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7585.85,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 4 1ST 30MIN","code_information":[{"code":"3601000683","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":4921.05,"maximum":7585.85,"gross_charge":9285,"discounted_cash":2126.27,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4921.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7585.85,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 4 ADD 15MIN","code_information":[{"code":"3601000684","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2026.19,"maximum":3123.4,"gross_charge":3823,"discounted_cash":875.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2026.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3123.4,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 4 ADD 15MIN","code_information":[{"code":"3601000684","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2026.19,"maximum":3123.4,"gross_charge":3823,"discounted_cash":875.47,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2026.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3123.4,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 5 1ST 30MIN","code_information":[{"code":"3601000685","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":6325.55,"maximum":9750.9,"gross_charge":11935,"discounted_cash":2733.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6325.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9750.9,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 5 1ST 30MIN","code_information":[{"code":"3601000685","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":6325.55,"maximum":9750.9,"gross_charge":11935,"discounted_cash":2733.12,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6325.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9750.9,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 5 ADD 15MIN","code_information":[{"code":"3601000686","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2187.31,"maximum":3371.76,"gross_charge":4127,"discounted_cash":945.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2187.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3371.76,"methodology":"fee schedule"}]}]},{"description":"SURGERY LEVEL 5 ADD 15MIN","code_information":[{"code":"3601000686","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2187.31,"maximum":3371.76,"gross_charge":4127,"discounted_cash":945.09,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2187.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3371.76,"methodology":"fee schedule"}]}]},{"description":"CHOLECYSTOSTOMY PERC","code_information":[{"code":"3601002380","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6811.03,"maximum":10499.27,"gross_charge":12851,"discounted_cash":2942.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6811.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10499.27,"methodology":"fee schedule"}]}]},{"description":"CHOLECYSTOSTOMY PERC","code_information":[{"code":"3601002380","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6811.03,"maximum":10499.27,"gross_charge":12851,"discounted_cash":2942.88,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6811.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10499.27,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES","code_information":[{"code":"3611","type":"APR-DRG"}],"standard_charges":[{"minimum":9655,"maximum":9655,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9655,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9655,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9655,"methodology":"case rate"}]}]},{"description":"PLACE NASO/OROGAS TUBE PHY SKL","code_information":[{"code":"3611000037","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":407.57,"maximum":628.28,"gross_charge":769,"discounted_cash":176.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":407.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":628.28,"methodology":"fee schedule"}]}]},{"description":"PLACE NASO/OROGAS TUBE PHY SKL","code_information":[{"code":"3611000037","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":407.57,"maximum":628.28,"gross_charge":769,"discounted_cash":176.11,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":407.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":628.28,"methodology":"fee schedule"}]}]},{"description":"EPIDURAL BLOOD PATCH","code_information":[{"code":"3611000052","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1126.78,"maximum":1736.95,"gross_charge":2126,"discounted_cash":486.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1126.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1736.95,"methodology":"fee schedule"}]}]},{"description":"EPIDURAL BLOOD PATCH","code_information":[{"code":"3611000052","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1126.78,"maximum":1736.95,"gross_charge":2126,"discounted_cash":486.86,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1126.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1736.95,"methodology":"fee schedule"}]}]},{"description":"INS/REPL/DECL NONTUN/PIC","code_information":[{"code":"3611000131","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":793.94,"maximum":1223.87,"gross_charge":1498,"discounted_cash":343.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":793.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1223.87,"methodology":"fee schedule"}]}]},{"description":"INS/REPL/DECL NONTUN/PIC","code_information":[{"code":"3611000131","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":793.94,"maximum":1223.87,"gross_charge":1498,"discounted_cash":343.05,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":793.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1223.87,"methodology":"fee schedule"}]}]},{"description":"PUNCTURE SPINAL LUMBAR DX","code_information":[{"code":"3611000142","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":782.28,"maximum":1205.9,"gross_charge":1476,"discounted_cash":338.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":782.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1205.9,"methodology":"fee schedule"}]}]},{"description":"PUNCTURE SPINAL LUMBAR DX","code_information":[{"code":"3611000142","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":782.28,"maximum":1205.9,"gross_charge":1476,"discounted_cash":338.01,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":782.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1205.9,"methodology":"fee schedule"}]}]},{"description":"BIOPSY/EXC LYMPH NODE SUPERFIC","code_information":[{"code":"3611000284","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6456.46,"maximum":9952.7,"gross_charge":12182,"discounted_cash":2789.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6456.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9952.7,"methodology":"fee schedule"}]}]},{"description":"BIOPSY/EXC LYMPH NODE SUPERFIC","code_information":[{"code":"3611000284","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6456.46,"maximum":9952.7,"gross_charge":12182,"discounted_cash":2789.68,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6456.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9952.7,"methodology":"fee schedule"}]}]},{"description":"BIOPSY THYROID NDL CORE PERC","code_information":[{"code":"3611000285","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1328.18,"maximum":2047.41,"gross_charge":2506,"discounted_cash":573.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1328.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2047.41,"methodology":"fee schedule"}]}]},{"description":"BIOPSY THYROID NDL CORE PERC","code_information":[{"code":"3611000285","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1328.18,"maximum":2047.41,"gross_charge":2506,"discounted_cash":573.88,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1328.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2047.41,"methodology":"fee schedule"}]}]},{"description":"BIOPSY RENAL NDL/TROCAR PERC","code_information":[{"code":"3611000286","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3152.44,"maximum":4859.52,"gross_charge":5948,"discounted_cash":1362.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3152.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4859.52,"methodology":"fee schedule"}]}]},{"description":"BIOPSY RENAL NDL/TROCAR PERC","code_information":[{"code":"3611000286","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3152.44,"maximum":4859.52,"gross_charge":5948,"discounted_cash":1362.1,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3152.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4859.52,"methodology":"fee schedule"}]}]},{"description":"PARACENTESIS ABD W IMAGING","code_information":[{"code":"3611000349","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1123.07,"maximum":1731.23,"gross_charge":2119,"discounted_cash":485.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1123.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1731.23,"methodology":"fee schedule"}]}]},{"description":"PARACENTESIS ABD W IMAGING","code_information":[{"code":"3611000349","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1123.07,"maximum":1731.23,"gross_charge":2119,"discounted_cash":485.26,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1123.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1731.23,"methodology":"fee schedule"}]}]},{"description":"THORACENTESIS W IMAGING UNI","code_information":[{"code":"3611000350","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1336.13,"maximum":2059.66,"gross_charge":2521,"discounted_cash":577.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1336.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2059.66,"methodology":"fee schedule"}]}]},{"description":"THORACENTESIS W IMAGING UNI","code_information":[{"code":"3611000350","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1336.13,"maximum":2059.66,"gross_charge":2521,"discounted_cash":577.31,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1336.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2059.66,"methodology":"fee schedule"}]}]},{"description":"BX BRST US PERC EA ADD LES","code_information":[{"code":"3611000358","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3153.5,"maximum":4861.15,"gross_charge":5950,"discounted_cash":1362.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3153.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4861.15,"methodology":"fee schedule"}]}]},{"description":"BX BRST US PERC EA ADD LES","code_information":[{"code":"3611000358","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3153.5,"maximum":4861.15,"gross_charge":5950,"discounted_cash":1362.55,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3153.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4861.15,"methodology":"fee schedule"}]}]},{"description":"INS CATH PLEURAL W IMAGING UNI","code_information":[{"code":"3611000361","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1650.95,"maximum":2544.96,"gross_charge":3115,"discounted_cash":713.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1650.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2544.96,"methodology":"fee schedule"}]}]},{"description":"INS CATH PLEURAL W IMAGING UNI","code_information":[{"code":"3611000361","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1650.95,"maximum":2544.96,"gross_charge":3115,"discounted_cash":713.34,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1650.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2544.96,"methodology":"fee schedule"}]}]},{"description":"BX BREAST US PERC 1ST LES UNI","code_information":[{"code":"3611000380","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":770.09,"maximum":1187.11,"gross_charge":1453,"discounted_cash":332.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":770.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1187.11,"methodology":"fee schedule"}]}]},{"description":"BX BREAST US PERC 1ST LES UNI","code_information":[{"code":"3611000380","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":770.09,"maximum":1187.11,"gross_charge":1453,"discounted_cash":332.74,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":770.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1187.11,"methodology":"fee schedule"}]}]},{"description":"BIOPSY PLEURA NEEDLE PERC","code_information":[{"code":"3611000928","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1721.97,"maximum":2654.44,"gross_charge":3249,"discounted_cash":744.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1721.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2654.44,"methodology":"fee schedule"}]}]},{"description":"BIOPSY PLEURA NEEDLE PERC","code_information":[{"code":"3611000928","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1721.97,"maximum":2654.44,"gross_charge":3249,"discounted_cash":744.03,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1721.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2654.44,"methodology":"fee schedule"}]}]},{"description":"BX LNG/MDSTNM NDL CORE W/GDE","code_information":[{"code":"3611002247","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1898.99,"maximum":2927.32,"gross_charge":3583,"discounted_cash":820.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1898.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2927.32,"methodology":"fee schedule"}]}]},{"description":"BX LNG/MDSTNM NDL CORE W/GDE","code_information":[{"code":"3611002247","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1898.99,"maximum":2927.32,"gross_charge":3583,"discounted_cash":820.51,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1898.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2927.32,"methodology":"fee schedule"}]}]},{"description":"I D PEL/HIP JOINT ABSCESS DEEP","code_information":[{"code":"3611002370","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4936.42,"maximum":7609.54,"gross_charge":9314,"discounted_cash":2132.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4936.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7609.54,"methodology":"fee schedule"}]}]},{"description":"I D PEL/HIP JOINT ABSCESS DEEP","code_information":[{"code":"3611002370","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4936.42,"maximum":7609.54,"gross_charge":9314,"discounted_cash":2132.91,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4936.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7609.54,"methodology":"fee schedule"}]}]},{"description":"BLADDER ABSCESS DRAIN","code_information":[{"code":"3611002371","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3524.5,"maximum":5433.05,"gross_charge":6650,"discounted_cash":1522.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3524.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5433.05,"methodology":"fee schedule"}]}]},{"description":"BLADDER ABSCESS DRAIN","code_information":[{"code":"3611002371","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3524.5,"maximum":5433.05,"gross_charge":6650,"discounted_cash":1522.85,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3524.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5433.05,"methodology":"fee schedule"}]}]},{"description":"BX AND ASPIR BONE MARRW DX UNI","code_information":[{"code":"3611002372","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3603.47,"maximum":5554.79,"gross_charge":6799,"discounted_cash":1556.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3603.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5554.79,"methodology":"fee schedule"}]}]},{"description":"BX AND ASPIR BONE MARRW DX UNI","code_information":[{"code":"3611002372","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3603.47,"maximum":5554.79,"gross_charge":6799,"discounted_cash":1556.98,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3603.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5554.79,"methodology":"fee schedule"}]}]},{"description":"BIOPSY ABD/RETROPERITONEL MASS","code_information":[{"code":"3611002373","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1773.91,"maximum":2734.5,"gross_charge":3347,"discounted_cash":766.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1773.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2734.5,"methodology":"fee schedule"}]}]},{"description":"BIOPSY ABD/RETROPERITONEL MASS","code_information":[{"code":"3611002373","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1773.91,"maximum":2734.5,"gross_charge":3347,"discounted_cash":766.47,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1773.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2734.5,"methodology":"fee schedule"}]}]},{"description":"BX ADRENAL GLAND NDL PERC","code_information":[{"code":"3611002374","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9837.86,"maximum":15165.16,"gross_charge":18562,"discounted_cash":4250.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9837.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15165.16,"methodology":"fee schedule"}]}]},{"description":"BX ADRENAL GLAND NDL PERC","code_information":[{"code":"3611002374","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9837.86,"maximum":15165.16,"gross_charge":18562,"discounted_cash":4250.7,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9837.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15165.16,"methodology":"fee schedule"}]}]},{"description":"BX BACK/FLNK SFT TIS DEEP","code_information":[{"code":"3611002375","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6834.88,"maximum":10536.04,"gross_charge":12896,"discounted_cash":2953.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6834.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10536.04,"methodology":"fee schedule"}]}]},{"description":"BX BACK/FLNK SFT TIS DEEP","code_information":[{"code":"3611002375","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6834.88,"maximum":10536.04,"gross_charge":12896,"discounted_cash":2953.19,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6834.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10536.04,"methodology":"fee schedule"}]}]},{"description":"BIOPSY(IES) BONE MARROW DX","code_information":[{"code":"3611002376","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2779.85,"maximum":4285.17,"gross_charge":5245,"discounted_cash":1201.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2779.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4285.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY(IES) BONE MARROW DX","code_information":[{"code":"3611002376","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2779.85,"maximum":4285.17,"gross_charge":5245,"discounted_cash":1201.11,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2779.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4285.17,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SFT TISS LEG/ANKLE","code_information":[{"code":"3611002378","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2965.35,"maximum":4571.12,"gross_charge":5595,"discounted_cash":1281.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2965.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4571.12,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SFT TISS LEG/ANKLE","code_information":[{"code":"3611002378","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2965.35,"maximum":4571.12,"gross_charge":5595,"discounted_cash":1281.26,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2965.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4571.12,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SPLEEN NEEDLE","code_information":[{"code":"3611002379","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1450.61,"maximum":2236.13,"gross_charge":2737,"discounted_cash":626.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1450.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2236.13,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SPLEEN NEEDLE","code_information":[{"code":"3611002379","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1450.61,"maximum":2236.13,"gross_charge":2737,"discounted_cash":626.78,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1450.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2236.13,"methodology":"fee schedule"}]}]},{"description":"IMAGE CATH FLUID PERITO/RETROP","code_information":[{"code":"3611002381","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3375.57,"maximum":5203.48,"gross_charge":6369,"discounted_cash":1458.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3375.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5203.48,"methodology":"fee schedule"}]}]},{"description":"IMAGE CATH FLUID PERITO/RETROP","code_information":[{"code":"3611002381","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3375.57,"maximum":5203.48,"gross_charge":6369,"discounted_cash":1458.51,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3375.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5203.48,"methodology":"fee schedule"}]}]},{"description":"IMAGE CATH FLUID SOFT TISSUE","code_information":[{"code":"3611002382","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2033.61,"maximum":3134.83,"gross_charge":3837,"discounted_cash":878.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2033.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3134.83,"methodology":"fee schedule"}]}]},{"description":"IMAGE CATH FLUID SOFT TISSUE","code_information":[{"code":"3611002382","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2033.61,"maximum":3134.83,"gross_charge":3837,"discounted_cash":878.68,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2033.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3134.83,"methodology":"fee schedule"}]}]},{"description":"PLC NEPHRO CATH W IMAGING UNI","code_information":[{"code":"3611002385","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3167.28,"maximum":4882.4,"gross_charge":5976,"discounted_cash":1368.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3167.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4882.4,"methodology":"fee schedule"}]}]},{"description":"PLC NEPHRO CATH W IMAGING UNI","code_information":[{"code":"3611002385","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3167.28,"maximum":4882.4,"gross_charge":5976,"discounted_cash":1368.51,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3167.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4882.4,"methodology":"fee schedule"}]}]},{"description":"EXCH NEPHROSTOM CTH W IMG UNI","code_information":[{"code":"3611002386","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4300.95,"maximum":6629.96,"gross_charge":8115,"discounted_cash":1858.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4300.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6629.96,"methodology":"fee schedule"}]}]},{"description":"EXCH NEPHROSTOM CTH W IMG UNI","code_information":[{"code":"3611002386","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4300.95,"maximum":6629.96,"gross_charge":8115,"discounted_cash":1858.34,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4300.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6629.96,"methodology":"fee schedule"}]}]},{"description":"CT PERICARDIOCENTESIS W IMAG","code_information":[{"code":"3611002388","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3852.04,"maximum":5937.96,"gross_charge":7268,"discounted_cash":1664.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3852.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5937.96,"methodology":"fee schedule"}]}]},{"description":"CT PERICARDIOCENTESIS W IMAG","code_information":[{"code":"3611002388","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3852.04,"maximum":5937.96,"gross_charge":7268,"discounted_cash":1664.38,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3852.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5937.96,"methodology":"fee schedule"}]}]},{"description":"US ARTHROCEN ASP INTERM JT/BUR","code_information":[{"code":"3611002410","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":610.03,"maximum":940.37,"gross_charge":1151,"discounted_cash":263.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":610.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":940.37,"methodology":"fee schedule"}]}]},{"description":"US ARTHROCEN ASP INTERM JT/BUR","code_information":[{"code":"3611002410","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":610.03,"maximum":940.37,"gross_charge":1151,"discounted_cash":263.58,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":610.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":940.37,"methodology":"fee schedule"}]}]},{"description":"US ARTHROCEN ASP MAJOR JT/BUR","code_information":[{"code":"3611002411","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":735.11,"maximum":1133.18,"gross_charge":1387,"discounted_cash":317.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":735.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1133.18,"methodology":"fee schedule"}]}]},{"description":"US ARTHROCEN ASP MAJOR JT/BUR","code_information":[{"code":"3611002411","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":735.11,"maximum":1133.18,"gross_charge":1387,"discounted_cash":317.63,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":735.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1133.18,"methodology":"fee schedule"}]}]},{"description":"US ARTHROCENT ASP SMALL JT/BUR","code_information":[{"code":"3611002412","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":624.87,"maximum":963.25,"gross_charge":1179,"discounted_cash":270,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":624.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":963.25,"methodology":"fee schedule"}]}]},{"description":"US ARTHROCENT ASP SMALL JT/BUR","code_information":[{"code":"3611002412","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":624.87,"maximum":963.25,"gross_charge":1179,"discounted_cash":270,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":624.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":963.25,"methodology":"fee schedule"}]}]},{"description":"FNA BX US GDE 1ST LESION","code_information":[{"code":"3611002416","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1492.48,"maximum":2300.68,"gross_charge":2816,"discounted_cash":644.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1492.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2300.68,"methodology":"fee schedule"}]}]},{"description":"FNA BX US GDE 1ST LESION","code_information":[{"code":"3611002416","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1492.48,"maximum":2300.68,"gross_charge":2816,"discounted_cash":644.87,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1492.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2300.68,"methodology":"fee schedule"}]}]},{"description":"ABSCES/CYST DRN CATH EXCHANGE","code_information":[{"code":"3611002417","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2324.05,"maximum":3582.55,"gross_charge":4385,"discounted_cash":1004.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2324.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3582.55,"methodology":"fee schedule"}]}]},{"description":"ABSCES/CYST DRN CATH EXCHANGE","code_information":[{"code":"3611002417","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2324.05,"maximum":3582.55,"gross_charge":4385,"discounted_cash":1004.17,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2324.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3582.55,"methodology":"fee schedule"}]}]},{"description":"THYROID CYST ASPIRATE/INJ","code_information":[{"code":"3611002419","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":795,"maximum":1225.5,"gross_charge":1500,"discounted_cash":343.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":795,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1225.5,"methodology":"fee schedule"}]}]},{"description":"THYROID CYST ASPIRATE/INJ","code_information":[{"code":"3611002419","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":795,"maximum":1225.5,"gross_charge":1500,"discounted_cash":343.5,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":795,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1225.5,"methodology":"fee schedule"}]}]},{"description":"PSEUDOANEURYSM TX EXTREM INJ","code_information":[{"code":"3611002420","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":863.37,"maximum":1330.9,"gross_charge":1629,"discounted_cash":373.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":863.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1330.9,"methodology":"fee schedule"}]}]},{"description":"PSEUDOANEURYSM TX EXTREM INJ","code_information":[{"code":"3611002420","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":863.37,"maximum":1330.9,"gross_charge":1629,"discounted_cash":373.05,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":863.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1330.9,"methodology":"fee schedule"}]}]},{"description":"CYSTOGRAM/VOID URETHROCY INJ","code_information":[{"code":"3611002421","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":811.43,"maximum":1250.83,"gross_charge":1531,"discounted_cash":350.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":811.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.83,"methodology":"fee schedule"}]}]},{"description":"CYSTOGRAM/VOID URETHROCY INJ","code_information":[{"code":"3611002421","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":811.43,"maximum":1250.83,"gross_charge":1531,"discounted_cash":350.6,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":811.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.83,"methodology":"fee schedule"}]}]},{"description":"INJ URETHROCYSTOGRAM RETROGRAD","code_information":[{"code":"3611002422","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":943.4,"maximum":1454.26,"gross_charge":1780,"discounted_cash":407.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":943.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1454.26,"methodology":"fee schedule"}]}]},{"description":"INJ URETHROCYSTOGRAM RETROGRAD","code_information":[{"code":"3611002422","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":943.4,"maximum":1454.26,"gross_charge":1780,"discounted_cash":407.62,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":943.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1454.26,"methodology":"fee schedule"}]}]},{"description":"REMOV TUN CV CATH WO PORT/PUMP","code_information":[{"code":"3611002430","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":698.54,"maximum":1076.81,"gross_charge":1318,"discounted_cash":301.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":698.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1076.81,"methodology":"fee schedule"}]}]},{"description":"REMOV TUN CV CATH WO PORT/PUMP","code_information":[{"code":"3611002430","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":698.54,"maximum":1076.81,"gross_charge":1318,"discounted_cash":301.83,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":698.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1076.81,"methodology":"fee schedule"}]}]},{"description":"ARTHROGRAM SHOULDER INJ UNI","code_information":[{"code":"3611002532","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":433.54,"maximum":668.31,"gross_charge":818,"discounted_cash":187.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":433.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":668.31,"methodology":"fee schedule"}]}]},{"description":"ARTHROGRAM SHOULDER INJ UNI","code_information":[{"code":"3611002532","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":433.54,"maximum":668.31,"gross_charge":818,"discounted_cash":187.33,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":433.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":668.31,"methodology":"fee schedule"}]}]},{"description":"INJ KNEE ARTHROGRAPHY CONTRAST","code_information":[{"code":"3611002537","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":687.94,"maximum":1060.47,"gross_charge":1298,"discounted_cash":297.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":687.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1060.47,"methodology":"fee schedule"}]}]},{"description":"INJ KNEE ARTHROGRAPHY CONTRAST","code_information":[{"code":"3611002537","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":687.94,"maximum":1060.47,"gross_charge":1298,"discounted_cash":297.25,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":687.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1060.47,"methodology":"fee schedule"}]}]},{"description":"DEBR SUBQ TISSUE EA ADD 20SQCM","code_information":[{"code":"3611003049","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":607.38,"maximum":936.29,"gross_charge":1146,"discounted_cash":262.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":607.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":936.29,"methodology":"fee schedule"}]}]},{"description":"DEBR SUBQ TISSUE EA ADD 20SQCM","code_information":[{"code":"3611003049","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":607.38,"maximum":936.29,"gross_charge":1146,"discounted_cash":262.44,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":607.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":936.29,"methodology":"fee schedule"}]}]},{"description":"DEBR SUBQ/MUSCLE EA ADD 20SQCM","code_information":[{"code":"3611003050","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":948.7,"maximum":1462.43,"gross_charge":1790,"discounted_cash":409.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":948.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1462.43,"methodology":"fee schedule"}]}]},{"description":"DEBR SUBQ/MUSCLE EA ADD 20SQCM","code_information":[{"code":"3611003050","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":948.7,"maximum":1462.43,"gross_charge":1790,"discounted_cash":409.91,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":948.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1462.43,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY PLANNED","code_information":[{"code":"3611003051","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11589.51,"maximum":17865.34,"gross_charge":21867,"discounted_cash":5007.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11589.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17865.34,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY PLANNED","code_information":[{"code":"3611003051","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11589.51,"maximum":17865.34,"gross_charge":21867,"discounted_cash":5007.55,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11589.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17865.34,"methodology":"fee schedule"}]}]},{"description":"INS TUN CTH PLEURAL W CUFF","code_information":[{"code":"3611003053","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7687.65,"maximum":11850.59,"gross_charge":14505,"discounted_cash":3321.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7687.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11850.59,"methodology":"fee schedule"}]}]},{"description":"INS TUN CTH PLEURAL W CUFF","code_information":[{"code":"3611003053","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7687.65,"maximum":11850.59,"gross_charge":14505,"discounted_cash":3321.65,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7687.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11850.59,"methodology":"fee schedule"}]}]},{"description":"THORACOSTOMY TUBE","code_information":[{"code":"3611003054","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3229.29,"maximum":4977.99,"gross_charge":6093,"discounted_cash":1395.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3229.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4977.99,"methodology":"fee schedule"}]}]},{"description":"THORACOSTOMY TUBE","code_information":[{"code":"3611003054","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3229.29,"maximum":4977.99,"gross_charge":6093,"discounted_cash":1395.3,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3229.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4977.99,"methodology":"fee schedule"}]}]},{"description":"THORACENTESIS WO IMAGING","code_information":[{"code":"3611003055","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1255.57,"maximum":1935.48,"gross_charge":2369,"discounted_cash":542.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1255.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1935.48,"methodology":"fee schedule"}]}]},{"description":"THORACENTESIS WO IMAGING","code_information":[{"code":"3611003055","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1255.57,"maximum":1935.48,"gross_charge":2369,"discounted_cash":542.51,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1255.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1935.48,"methodology":"fee schedule"}]}]},{"description":"INS CATH PLEURAL WO IMAGING","code_information":[{"code":"3611003057","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3779.96,"maximum":5826.85,"gross_charge":7132,"discounted_cash":1633.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3779.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5826.85,"methodology":"fee schedule"}]}]},{"description":"INS CATH PLEURAL WO IMAGING","code_information":[{"code":"3611003057","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3779.96,"maximum":5826.85,"gross_charge":7132,"discounted_cash":1633.23,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3779.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5826.85,"methodology":"fee schedule"}]}]},{"description":"INSERT NONTUNNEL CV CATH >5YR","code_information":[{"code":"3611003058","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7107.83,"maximum":10956.79,"gross_charge":13411,"discounted_cash":3071.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7107.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10956.79,"methodology":"fee schedule"}]}]},{"description":"INSERT NONTUNNEL CV CATH >5YR","code_information":[{"code":"3611003058","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7107.83,"maximum":10956.79,"gross_charge":13411,"discounted_cash":3071.12,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7107.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10956.79,"methodology":"fee schedule"}]}]},{"description":"PARACENTESIS ABD WO IMAGING","code_information":[{"code":"3611003059","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1790.34,"maximum":2759.83,"gross_charge":3378,"discounted_cash":773.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1790.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2759.83,"methodology":"fee schedule"}]}]},{"description":"PARACENTESIS ABD WO IMAGING","code_information":[{"code":"3611003059","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1790.34,"maximum":2759.83,"gross_charge":3378,"discounted_cash":773.57,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1790.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2759.83,"methodology":"fee schedule"}]}]},{"description":"DEBR MUSCLE/FASCIA 1ST 20 SQCM","code_information":[{"code":"3611003062","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1260.87,"maximum":1943.65,"gross_charge":2379,"discounted_cash":544.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1260.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1943.65,"methodology":"fee schedule"}]}]},{"description":"DEBR MUSCLE/FASCIA 1ST 20 SQCM","code_information":[{"code":"3611003062","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1260.87,"maximum":1943.65,"gross_charge":2379,"discounted_cash":544.8,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1260.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1943.65,"methodology":"fee schedule"}]}]},{"description":"REMOVE BILI DRN CATH W FLUORO","code_information":[{"code":"3611003111","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1904.29,"maximum":2935.49,"gross_charge":3593,"discounted_cash":822.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1904.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2935.49,"methodology":"fee schedule"}]}]},{"description":"REMOVE BILI DRN CATH W FLUORO","code_information":[{"code":"3611003111","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1904.29,"maximum":2935.49,"gross_charge":3593,"discounted_cash":822.8,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1904.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2935.49,"methodology":"fee schedule"}]}]},{"description":"ARTHRO ASP MAJOR JT WO US UNI","code_information":[{"code":"3611003112","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":622.22,"maximum":959.16,"gross_charge":1174,"discounted_cash":268.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":622.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":959.16,"methodology":"fee schedule"}]}]},{"description":"ARTHRO ASP MAJOR JT WO US UNI","code_information":[{"code":"3611003112","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":622.22,"maximum":959.16,"gross_charge":1174,"discounted_cash":268.85,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":622.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":959.16,"methodology":"fee schedule"}]}]},{"description":"INTRO NDL/INTRACATH VEIN","code_information":[{"code":"3611003114","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":183.38,"maximum":282.69,"gross_charge":346,"discounted_cash":79.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":183.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":282.69,"methodology":"fee schedule"}]}]},{"description":"INTRO NDL/INTRACATH VEIN","code_information":[{"code":"3611003114","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":183.38,"maximum":282.69,"gross_charge":346,"discounted_cash":79.24,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":183.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":282.69,"methodology":"fee schedule"}]}]},{"description":"JEJUNOSTMY TUBE REPL PERC","code_information":[{"code":"3611003120","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1476.58,"maximum":2276.17,"gross_charge":2786,"discounted_cash":638,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1476.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2276.17,"methodology":"fee schedule"}]}]},{"description":"JEJUNOSTMY TUBE REPL PERC","code_information":[{"code":"3611003120","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1476.58,"maximum":2276.17,"gross_charge":2786,"discounted_cash":638,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1476.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2276.17,"methodology":"fee schedule"}]}]},{"description":"XR SPNL PUNC LUMB W FLR OR CT","code_information":[{"code":"3611003126","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1530.64,"maximum":2359.5,"gross_charge":2888,"discounted_cash":661.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1530.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2359.5,"methodology":"fee schedule"}]}]},{"description":"XR SPNL PUNC LUMB W FLR OR CT","code_information":[{"code":"3611003126","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1530.64,"maximum":2359.5,"gross_charge":2888,"discounted_cash":661.36,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1530.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2359.5,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES","code_information":[{"code":"3612","type":"APR-DRG"}],"standard_charges":[{"minimum":11917,"maximum":11917,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11917,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11917,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11917,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES","code_information":[{"code":"3613","type":"APR-DRG"}],"standard_charges":[{"minimum":19611,"maximum":19611,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19611,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19611,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19611,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES","code_information":[{"code":"3614","type":"APR-DRG"}],"standard_charges":[{"minimum":37803,"maximum":37803,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37803,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37803,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37803,"methodology":"case rate"}]}]},{"description":"MASTECTOMY PROCEDURES","code_information":[{"code":"3621","type":"APR-DRG"}],"standard_charges":[{"minimum":8003,"maximum":8003,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8003,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8003,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8003,"methodology":"case rate"}]}]},{"description":"MASTECTOMY PROCEDURES","code_information":[{"code":"3622","type":"APR-DRG"}],"standard_charges":[{"minimum":11020,"maximum":11020,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11020,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11020,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11020,"methodology":"case rate"}]}]},{"description":"MASTECTOMY PROCEDURES","code_information":[{"code":"3623","type":"APR-DRG"}],"standard_charges":[{"minimum":14048,"maximum":14048,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14048,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14048,"methodology":"case rate"}]}]},{"description":"MASTECTOMY PROCEDURES","code_information":[{"code":"3624","type":"APR-DRG"}],"standard_charges":[{"minimum":16627,"maximum":16627,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16627,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16627,"methodology":"case rate"}]}]},{"description":"BREAST PROCEDURES EXCEPT MASTECTOMY","code_information":[{"code":"3631","type":"APR-DRG"}],"standard_charges":[{"minimum":7705,"maximum":7705,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7705,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7705,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7705,"methodology":"case rate"}]}]},{"description":"BREAST PROCEDURES EXCEPT MASTECTOMY","code_information":[{"code":"3632","type":"APR-DRG"}],"standard_charges":[{"minimum":13284,"maximum":13284,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13284,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13284,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13284,"methodology":"case rate"}]}]},{"description":"BREAST PROCEDURES EXCEPT MASTECTOMY","code_information":[{"code":"3633","type":"APR-DRG"}],"standard_charges":[{"minimum":16306,"maximum":16306,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16306,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16306,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16306,"methodology":"case rate"}]}]},{"description":"BREAST PROCEDURES EXCEPT MASTECTOMY","code_information":[{"code":"3634","type":"APR-DRG"}],"standard_charges":[{"minimum":22999,"maximum":22999,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22999,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22999,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22999,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND RELATED PROCEDURES","code_information":[{"code":"3641","type":"APR-DRG"}],"standard_charges":[{"minimum":5027,"maximum":5027,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5027,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5027,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5027,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND RELATED PROCEDURES","code_information":[{"code":"3642","type":"APR-DRG"}],"standard_charges":[{"minimum":6975,"maximum":6975,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6975,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6975,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6975,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND RELATED PROCEDURES","code_information":[{"code":"3643","type":"APR-DRG"}],"standard_charges":[{"minimum":11567,"maximum":11567,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11567,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11567,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11567,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND RELATED PROCEDURES","code_information":[{"code":"3644","type":"APR-DRG"}],"standard_charges":[{"minimum":22093,"maximum":22093,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22093,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22093,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22093,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITH MCC","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"minimum":14187.44,"maximum":39271.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35759,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35759,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27563.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20672.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20672.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34597.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28531.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39271.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14187.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14329.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14613.07,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14471.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14187.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14187.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14187.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14542.13,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14187.44,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITH CC","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"minimum":9142.42,"maximum":21931.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19970,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19970,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21665.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16249.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16249.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19321.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15933.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21931.75,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9142.42,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9233.85,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9416.7,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9325.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9142.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9142.42,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9142.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9370.99,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9142.42,"methodology":"case rate"}]}]},{"description":"ANESTHESIA - GENERAL","code_information":[{"code":"370","type":"RC"}],"standard_charges":[{"minimum":697.01,"maximum":929.19,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":929.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":697.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":697.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"minimum":6670.95,"maximum":19104.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14038,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14038,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19104.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14328.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14328.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13582.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11200.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15416.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6670.95,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6737.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6871.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6804.37,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6670.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6670.95,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6670.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6837.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6670.95,"methodology":"case rate"}]}]},{"description":"ANESTH GENERAL 1ST 30MIN","code_information":[{"code":"3701000671","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":2427.4,"maximum":3741.86,"gross_charge":4580,"discounted_cash":1048.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2427.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3741.86,"methodology":"fee schedule"}]}]},{"description":"ANESTH GENERAL 1ST 30MIN","code_information":[{"code":"3701000671","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":641.2,"maximum":3741.86,"gross_charge":4580,"discounted_cash":1048.82,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2427.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3741.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.2,"methodology":"fee schedule"}]}]},{"description":"ANESTH GENERAL ADDL 15MIN","code_information":[{"code":"3701000672","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":401.74,"maximum":619.29,"gross_charge":758,"discounted_cash":173.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":401.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":619.29,"methodology":"fee schedule"}]}]},{"description":"ANESTH GENERAL ADDL 15MIN","code_information":[{"code":"3701000672","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":106.12,"maximum":619.29,"gross_charge":758,"discounted_cash":173.59,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":401.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":619.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.12,"methodology":"fee schedule"}]}]},{"description":"LOCAL ANESTHESIA","code_information":[{"code":"3701000673","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":590.42,"maximum":910.14,"gross_charge":1114,"discounted_cash":255.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":590.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":910.14,"methodology":"fee schedule"}]}]},{"description":"LOCAL ANESTHESIA","code_information":[{"code":"3701000673","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":155.96,"maximum":910.14,"gross_charge":1114,"discounted_cash":255.11,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":590.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":910.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.96,"methodology":"fee schedule"}]}]},{"description":"ANESTHESIA - ANESTHESIA INCIDENT TO RADIOLOGY","code_information":[{"code":"371","type":"RC"}],"standard_charges":[{"minimum":326.26,"maximum":434.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":326.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":326.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":14790.62,"maximum":35597.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32413,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32413,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33319.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24989.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24989.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31360.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25861.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35597.06,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14790.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14938.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15234.34,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15086.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14790.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14790.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14790.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15160.39,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14790.62,"methodology":"case rate"}]}]},{"description":"ANESTHESIA - ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC SERVICES","code_information":[{"code":"372","type":"RC"}],"standard_charges":[{"minimum":207.62,"maximum":276.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"minimum":9232.9,"maximum":26753.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19207,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19207,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26753.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20065.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20065.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18583.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15325.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21094.17,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9232.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9325.23,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9509.89,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9417.56,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9232.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9232.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9232.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9463.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9232.9,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":6882.83,"maximum":22756.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13934,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13934,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22756.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17067.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17067.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13482.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11118.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15303.33,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6882.83,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6951.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7089.32,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7020.49,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6882.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6882.83,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6882.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7054.91,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6882.83,"methodology":"case rate"}]}]},{"description":"ANESTHESIA - ACUPUNCTURE","code_information":[{"code":"374","type":"RC"}],"standard_charges":[{"minimum":207.62,"maximum":276.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DIGESTIVE MALIGNANCY WITH MCC","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"minimum":17600.8,"maximum":41208.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37523,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37523,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33222.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24917.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24917.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":36304.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29938.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41208.42,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17776.81,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18128.83,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17952.82,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18040.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY WITH CC","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"minimum":10774.86,"maximum":25715.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22679,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22679,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25715.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19286.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19286.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21942.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18095.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24906.59,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10774.86,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10882.61,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11098.11,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10990.36,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10774.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10774.86,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10774.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11044.24,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10774.86,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"minimum":8101.56,"maximum":20656.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18809,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18809,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19800.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14850.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14850.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18198.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15007.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20656.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8101.56,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8182.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8344.61,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8263.6,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8101.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8101.56,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8101.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8304.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8101.56,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL HEMORRHAGE WITH MCC","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":15333.47,"maximum":36513.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33247,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33247,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27075.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20306.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20306.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32167.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26527.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36513.03,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15333.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15486.81,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15793.48,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15640.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15333.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15333.47,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15333.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15716.81,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15333.47,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL HEMORRHAGE WITH CC","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"minimum":8897.28,"maximum":20651.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18561,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18561,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20651.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15489.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15489.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17958.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14809.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20384.5,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8897.28,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8986.26,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9164.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9075.23,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8897.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8897.28,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8897.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9119.72,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8897.28,"methodology":"case rate"}]}]},{"description":"ANESTHESIA - OTHER","code_information":[{"code":"379","type":"RC"}],"standard_charges":[{"minimum":207.62,"maximum":276.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"minimum":6196.91,"maximum":17166.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12129,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12129,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17166.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12875.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12875.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11735.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9677.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13320.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6196.91,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6258.88,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6382.82,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6320.85,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6196.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6196.91,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6196.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6351.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6196.91,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"380","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"COMPLICATED PEPTIC ULCER WITH MCC","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"minimum":16153.95,"maximum":38941.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35458,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35458,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28785.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21589.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21589.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34307.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28291.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38941.18,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16153.95,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16315.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16638.57,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16477.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16153.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16153.95,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16153.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16557.8,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16153.95,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS","code_information":[{"code":"3801","type":"APR-DRG"}],"standard_charges":[{"minimum":3695,"maximum":3695,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3695,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3695,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3695,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS","code_information":[{"code":"3802","type":"APR-DRG"}],"standard_charges":[{"minimum":4494,"maximum":4494,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4494,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4494,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4494,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS","code_information":[{"code":"3803","type":"APR-DRG"}],"standard_charges":[{"minimum":6862,"maximum":6862,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6862,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6862,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6862,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS","code_information":[{"code":"3804","type":"APR-DRG"}],"standard_charges":[{"minimum":14417,"maximum":14417,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14417,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14417,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14417,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"381","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"COMPLICATED PEPTIC ULCER WITH CC","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"minimum":9695.33,"maximum":22693.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20225,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20225,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22693.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17020.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17020.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19569.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16137.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22212.32,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9695.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9792.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9986.19,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9889.24,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9695.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9695.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9695.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9937.72,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9695.33,"methodology":"case rate"}]}]},{"description":"MAJOR SKIN DISORDERS","code_information":[{"code":"3811","type":"APR-DRG"}],"standard_charges":[{"minimum":2817,"maximum":2817,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2817,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2817,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2817,"methodology":"case rate"}]}]},{"description":"MAJOR SKIN DISORDERS","code_information":[{"code":"3812","type":"APR-DRG"}],"standard_charges":[{"minimum":5045,"maximum":5045,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5045,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5045,"methodology":"case rate"}]}]},{"description":"MAJOR SKIN DISORDERS","code_information":[{"code":"3813","type":"APR-DRG"}],"standard_charges":[{"minimum":9497,"maximum":9497,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9497,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9497,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9497,"methodology":"case rate"}]}]},{"description":"MAJOR SKIN DISORDERS","code_information":[{"code":"3814","type":"APR-DRG"}],"standard_charges":[{"minimum":22793,"maximum":22793,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22793,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22793,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22793,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"382","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"COMPLICATED PEPTIC ULCER WITHOUT CC/MCC","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"minimum":7067.65,"maximum":19402.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14866,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14866,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19402.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14552.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14552.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14383.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11861.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16326.58,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7067.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7138.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7279.68,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7209.01,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7067.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7067.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7067.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7244.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7067.65,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS","code_information":[{"code":"3821","type":"APR-DRG"}],"standard_charges":[{"minimum":4064,"maximum":4064,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4064,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4064,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4064,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS","code_information":[{"code":"3822","type":"APR-DRG"}],"standard_charges":[{"minimum":5213,"maximum":5213,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5213,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5213,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5213,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS","code_information":[{"code":"3823","type":"APR-DRG"}],"standard_charges":[{"minimum":7280,"maximum":7280,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7280,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7280,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7280,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS","code_information":[{"code":"3824","type":"APR-DRG"}],"standard_charges":[{"minimum":12244,"maximum":12244,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12244,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12244,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12244,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"383","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"UNCOMPLICATED PEPTIC ULCER WITH MCC","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"minimum":11049.38,"maximum":27361.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24914,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24914,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22105.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16579.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16579.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24105.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19878.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27361.56,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11049.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11159.88,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11380.87,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11270.37,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11049.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11049.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11049.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11325.62,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11049.38,"methodology":"case rate"}]}]},{"description":"CELLULITIS AND OTHER SKIN INFECTIONS","code_information":[{"code":"3831","type":"APR-DRG"}],"standard_charges":[{"minimum":2862,"maximum":2862,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2862,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2862,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2862,"methodology":"case rate"}]}]},{"description":"CELLULITIS AND OTHER SKIN INFECTIONS","code_information":[{"code":"3832","type":"APR-DRG"}],"standard_charges":[{"minimum":3795,"maximum":3795,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3795,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3795,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3795,"methodology":"case rate"}]}]},{"description":"CELLULITIS AND OTHER SKIN INFECTIONS","code_information":[{"code":"3833","type":"APR-DRG"}],"standard_charges":[{"minimum":5733,"maximum":5733,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5733,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5733,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5733,"methodology":"case rate"}]}]},{"description":"CELLULITIS AND OTHER SKIN INFECTIONS","code_information":[{"code":"3834","type":"APR-DRG"}],"standard_charges":[{"minimum":11531,"maximum":11531,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"384","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"UNCOMPLICATED PEPTIC ULCER WITHOUT MCC","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"minimum":7997.93,"maximum":17952.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16346,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16346,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16512.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12384.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12384.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15815.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13042.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17952.22,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7997.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8077.91,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8237.87,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8157.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7997.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7997.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7997.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8197.88,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7997.93,"methodology":"case rate"}]}]},{"description":"CONTUSION OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE","code_information":[{"code":"3841","type":"APR-DRG"}],"standard_charges":[{"minimum":3763,"maximum":3763,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3763,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3763,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3763,"methodology":"case rate"}]}]},{"description":"CONTUSION OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE","code_information":[{"code":"3842","type":"APR-DRG"}],"standard_charges":[{"minimum":4547,"maximum":4547,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"}]}]},{"description":"CONTUSION OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE","code_information":[{"code":"3843","type":"APR-DRG"}],"standard_charges":[{"minimum":6658,"maximum":6658,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6658,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6658,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6658,"methodology":"case rate"}]}]},{"description":"CONTUSION OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE","code_information":[{"code":"3844","type":"APR-DRG"}],"standard_charges":[{"minimum":12590,"maximum":12590,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12590,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12590,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12590,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"385","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITH MCC","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"minimum":13837.91,"maximum":33220.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30249,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30249,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30429.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22822.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22822.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29267.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24135.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33220.48,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13837.91,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13976.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14253.05,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14114.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13837.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13837.91,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13837.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14183.86,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13837.91,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST DISORDERS","code_information":[{"code":"3851","type":"APR-DRG"}],"standard_charges":[{"minimum":3006,"maximum":3006,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3006,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3006,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3006,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST DISORDERS","code_information":[{"code":"3852","type":"APR-DRG"}],"standard_charges":[{"minimum":3818,"maximum":3818,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3818,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3818,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3818,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST DISORDERS","code_information":[{"code":"3853","type":"APR-DRG"}],"standard_charges":[{"minimum":5909,"maximum":5909,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5909,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5909,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5909,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST DISORDERS","code_information":[{"code":"3854","type":"APR-DRG"}],"standard_charges":[{"minimum":12525,"maximum":12525,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12525,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12525,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12525,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"386","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITH CC","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"minimum":8948.32,"maximum":21932.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18506,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18506,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21932.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16449.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16449.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17906.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14766.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20324.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8948.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9037.81,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9216.77,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9127.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8948.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8948.32,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8948.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9172.03,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8948.32,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"387","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"minimum":6456.74,"maximum":19329.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13162,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13162,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19329.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14497.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14497.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12735.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10502.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14455.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6456.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6521.31,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6650.45,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6585.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6456.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6456.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6456.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6618.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6456.74,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"388","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL OBSTRUCTION WITH MCC","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"minimum":12640.06,"maximum":31462.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28649,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28649,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26196.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19647.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19647.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27718.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22858.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31462.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12640.06,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12766.47,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13019.27,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12892.87,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12640.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12640.06,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12640.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12956.07,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12640.06,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"389","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL OBSTRUCTION WITH CC","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":7472.09,"maximum":19419.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15773,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15773,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19419.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14565.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14565.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15261.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12585.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17323.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7472.09,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7546.82,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7696.26,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7621.54,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7472.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7472.09,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7472.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7658.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7472.09,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"390","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"minimum":5504.81,"maximum":14788.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10887,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10887,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14788.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11091.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11091.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10534.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8687.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11957.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5504.81,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5559.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5669.96,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5614.91,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5504.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5504.81,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5504.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5642.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5504.81,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"391","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"ESOPHAGITIS GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":11206.36,"maximum":25478.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23199,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23199,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18329.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13747.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13747.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22446.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18510.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25478.05,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11206.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11318.43,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11542.56,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11430.49,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11206.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11206.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11206.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11486.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11206.36,"methodology":"case rate"}]}]},{"description":"BLOOD AND BLOOD RELATED SERVICES","code_information":[{"code":"392","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"ESOPHAGITIS GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":7307.37,"maximum":15709.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14304,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14304,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13646.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10235.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10235.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13840.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11413.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15709.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7307.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7380.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7526.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7453.52,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7307.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7307.37,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7307.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7490.06,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7307.37,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":14079.18,"maximum":33513.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30516,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30516,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28466.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21350.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21350.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29525.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24348,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33513.43,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14079.18,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14219.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14501.56,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14360.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14079.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14079.18,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14079.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14431.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14079.18,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":8552.39,"maximum":22060.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17622,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17622,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22060.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16545.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16545.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17049.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14060.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19353,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8552.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8637.92,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8808.97,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8723.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8552.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8552.39,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8552.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8766.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8552.39,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"minimum":6194.59,"maximum":16934.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12292,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12292,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16934.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12701.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12701.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11893.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9808.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13500.27,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6194.59,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6256.54,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6380.43,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6318.49,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6194.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6194.59,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6194.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6349.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6194.59,"methodology":"case rate"}]}]},{"description":"APPENDIX PROCEDURES WITH MCC","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"minimum":20434.17,"maximum":43826.64,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43826.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32870.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32870.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20434.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20638.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21047.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20842.86,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20434.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20434.17,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20434.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20945.03,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20434.17,"methodology":"case rate"}]}]},{"description":"APPENDIX PROCEDURES WITH CC","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"minimum":12974.9,"maximum":34101.23,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34101.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25576.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25576.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12974.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13104.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13364.15,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13234.4,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12974.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12974.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12974.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13299.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12974.9,"methodology":"case rate"}]}]},{"description":"APPENDIX PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"minimum":9963.67,"maximum":24033.18,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24033.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18025.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18025.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9963.67,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10063.31,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10262.59,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10162.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9963.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9963.67,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9963.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10212.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9963.67,"methodology":"case rate"}]}]},{"description":"BLOOD STORAGE AND PROCESSING - OTHER","code_information":[{"code":"399","type":"RC"}],"standard_charges":[{"minimum":347.08,"maximum":512,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":462.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":347.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":347.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"ADRENAL PROCEDURES","code_information":[{"code":"4011","type":"APR-DRG"}],"standard_charges":[{"minimum":8020,"maximum":8020,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8020,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8020,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8020,"methodology":"case rate"}]}]},{"description":"ADRENAL PROCEDURES","code_information":[{"code":"4012","type":"APR-DRG"}],"standard_charges":[{"minimum":15644,"maximum":15644,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15644,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15644,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15644,"methodology":"case rate"}]}]},{"description":"ADRENAL PROCEDURES","code_information":[{"code":"4013","type":"APR-DRG"}],"standard_charges":[{"minimum":21133,"maximum":21133,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21133,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21133,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21133,"methodology":"case rate"}]}]},{"description":"ADRENAL PROCEDURES","code_information":[{"code":"4014","type":"APR-DRG"}],"standard_charges":[{"minimum":26178,"maximum":26178,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26178,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26178,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26178,"methodology":"case rate"}]}]},{"description":"SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"minimum":31526.42,"maximum":119058.4,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119058.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":89295.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":89295.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31526.42,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31841.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32472.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32156.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31526.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31526.42,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31526.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32314.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31526.42,"methodology":"case rate"}]}]},{"description":"PROCEDURES FOR OBESITY","code_information":[{"code":"4031","type":"APR-DRG"}],"standard_charges":[{"minimum":6926,"maximum":6926,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6926,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6926,"methodology":"case rate"}]}]},{"description":"PROCEDURES FOR OBESITY","code_information":[{"code":"4032","type":"APR-DRG"}],"standard_charges":[{"minimum":8010,"maximum":8010,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8010,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8010,"methodology":"case rate"}]}]},{"description":"PROCEDURES FOR OBESITY","code_information":[{"code":"4033","type":"APR-DRG"}],"standard_charges":[{"minimum":12846,"maximum":12846,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12846,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12846,"methodology":"case rate"}]}]},{"description":"PROCEDURES FOR OBESITY","code_information":[{"code":"4034","type":"APR-DRG"}],"standard_charges":[{"minimum":28175,"maximum":28175,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28175,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28175,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28175,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES","code_information":[{"code":"4041","type":"APR-DRG"}],"standard_charges":[{"minimum":5798,"maximum":5798,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5798,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5798,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5798,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES","code_information":[{"code":"4042","type":"APR-DRG"}],"standard_charges":[{"minimum":8617,"maximum":8617,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8617,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8617,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8617,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES","code_information":[{"code":"4043","type":"APR-DRG"}],"standard_charges":[{"minimum":15968,"maximum":15968,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15968,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15968,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15968,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES","code_information":[{"code":"4044","type":"APR-DRG"}],"standard_charges":[{"minimum":30245,"maximum":30245,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30245,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30245,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30245,"methodology":"case rate"}]}]},{"description":"PANCREAS LIVER AND SHUNT PROCEDURES WITH MCC","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"minimum":43253.54,"maximum":111963.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101949,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101949,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104148.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78112.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78112.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":98639.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":81342.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":111963.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":43253.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43686.08,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44551.15,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":44118.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":43253.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":43253.54,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":43253.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44334.88,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":43253.54,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS","code_information":[{"code":"4051","type":"APR-DRG"}],"standard_charges":[{"minimum":8603,"maximum":8603,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8603,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8603,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8603,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS","code_information":[{"code":"4052","type":"APR-DRG"}],"standard_charges":[{"minimum":10207,"maximum":10207,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10207,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10207,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10207,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS","code_information":[{"code":"4053","type":"APR-DRG"}],"standard_charges":[{"minimum":15362,"maximum":15362,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15362,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15362,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15362,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS","code_information":[{"code":"4054","type":"APR-DRG"}],"standard_charges":[{"minimum":33859,"maximum":33859,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33859,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33859,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33859,"methodology":"case rate"}]}]},{"description":"PANCREAS LIVER AND SHUNT PROCEDURES WITH CC","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"minimum":22990.71,"maximum":70074.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52427,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52427,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70074.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52557.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52557.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":50724.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":41830,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":57576.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22990.71,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23220.62,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23680.44,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23450.53,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22990.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22990.71,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22990.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23565.48,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22990.71,"methodology":"case rate"}]}]},{"description":"PANCREAS LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"minimum":17789.48,"maximum":48422.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39191,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39191,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48422.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36317.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36317.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37918.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31269.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43040.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17789.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17967.38,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18323.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18145.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17789.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17789.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17789.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18234.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17789.48,"methodology":"case rate"}]}]},{"description":"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"minimum":28348.92,"maximum":85043.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66942,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66942,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85043.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":63784,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":63784,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":64768.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":53411.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":73517.06,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28348.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28632.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29199.39,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28915.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28348.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28348.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28348.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29057.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28348.92,"methodology":"case rate"}]}]},{"description":"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"minimum":17485.57,"maximum":64270.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44967,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44967,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64270.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48204.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48204.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":43507.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":35878.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49384.09,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17485.57,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17660.43,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18010.14,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17835.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17485.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17485.57,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17485.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17922.71,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17485.57,"methodology":"case rate"}]}]},{"description":"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"minimum":13267.99,"maximum":45885.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31183,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31183,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45885.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34415.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34415.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30170.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24880.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34245.8,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13267.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13400.67,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13666.03,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13533.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13267.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13267.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13267.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13599.69,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13267.99,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SERVICES","code_information":[{"code":"410","type":"RC"}],"standard_charges":[{"minimum":426,"maximum":515,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":504,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":426,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":515,"methodology":"case rate"}]}]},{"description":"TRACH TUBE CHNG BEFORE FISTULA","code_information":[{"code":"4101000670","type":"CDM"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":507.74,"maximum":782.69,"gross_charge":958,"discounted_cash":219.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":507.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":782.69,"methodology":"fee schedule"}]}]},{"description":"TRACH TUBE CHNG BEFORE FISTULA","code_information":[{"code":"4101000670","type":"CDM"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":507.74,"maximum":782.69,"gross_charge":958,"discounted_cash":219.39,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":507.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":782.69,"methodology":"fee schedule"}]}]},{"description":"CHOLECYSTECTOMY WITH C.D.E. WITH MCC","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"minimum":22433.93,"maximum":79021.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71954,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71954,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76927.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57696.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57696.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":69617.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":57410.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":79021.15,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22433.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22658.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23106.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22882.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22433.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22433.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22433.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22994.78,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22433.93,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY WITH C.D.E. WITH CC","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"minimum":17757,"maximum":59466.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44651,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44651,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59466.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44601.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44601.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":43201.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":35626.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49037.51,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17757,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17934.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18289.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18112.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17757,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17757,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17757,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18200.93,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17757,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SERVICES","code_information":[{"code":"412","type":"RC"}],"standard_charges":[{"minimum":426,"maximum":515,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":504,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":426,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":515,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"minimum":14129.44,"maximum":45699.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30380,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30380,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45699.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34274.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34274.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29394.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24240.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33364.89,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14129.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14270.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14553.33,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14412.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14129.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14129.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14129.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14482.68,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14129.44,"methodology":"case rate"}]}]},{"description":"HYPERBARIC","code_information":[{"code":"413","type":"RC"}],"standard_charges":[{"minimum":3376,"maximum":4111,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4043,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3376,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4111,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"minimum":28368.25,"maximum":70480.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64177,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64177,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63675.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47757.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47757.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":62093.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":51205,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70480.33,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28368.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28651.94,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29219.3,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28935.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28368.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28368.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28368.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29077.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28368.25,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"minimum":16569.98,"maximum":46816.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38541,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38541,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46816.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35113.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35113.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37289.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30750.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42326.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16569.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16735.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17067.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16901.38,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16569.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16569.98,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16569.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16984.23,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16569.98,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"minimum":11869.08,"maximum":31688.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25365,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25365,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31688.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23767.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23767.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24541.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20238.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27856.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11869.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11987.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12225.16,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12106.47,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11869.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11869.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11869.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12165.81,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11869.08,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"minimum":19650.82,"maximum":49732.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45284,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45284,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36807.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27606.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27606.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":43814.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36131.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49732.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19650.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19847.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20240.35,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20043.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19650.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19650.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19650.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20142.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19650.82,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"minimum":14097.74,"maximum":34429.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31350,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31350,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29470.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22103.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22103.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30332.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25013.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34429.4,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14097.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14238.72,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14520.68,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14379.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14097.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14097.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14097.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14450.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14097.74,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"minimum":11462.33,"maximum":26959.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24548,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24548,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21364.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16023.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16023.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23751.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19586.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26959.28,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11462.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11576.96,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11806.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11691.58,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11462.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11462.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11462.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11748.89,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11462.33,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SERVICES","code_information":[{"code":"419","type":"RC"}],"standard_charges":[{"minimum":426,"maximum":515,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":504,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":426,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":515,"methodology":"case rate"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"minimum":28566.99,"maximum":74252.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64522,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64522,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74252.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55690.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55690.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":62427.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":51480.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70859.92,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28566.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28852.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29424,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29138.33,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28566.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28566.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28566.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29281.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28566.99,"methodology":"case rate"}]}]},{"description":"PT","code_information":[{"code":"420","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"DIABETES","code_information":[{"code":"4201","type":"APR-DRG"}],"standard_charges":[{"minimum":2876,"maximum":2876,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2876,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2876,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2876,"methodology":"case rate"}]}]},{"description":"DIABETES","code_information":[{"code":"4202","type":"APR-DRG"}],"standard_charges":[{"minimum":3468,"maximum":3468,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3468,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3468,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3468,"methodology":"case rate"}]}]},{"description":"DIABETES","code_information":[{"code":"4203","type":"APR-DRG"}],"standard_charges":[{"minimum":5294,"maximum":5294,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5294,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5294,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5294,"methodology":"case rate"}]}]},{"description":"DIABETES","code_information":[{"code":"4204","type":"APR-DRG"}],"standard_charges":[{"minimum":11305,"maximum":11305,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11305,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11305,"methodology":"case rate"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"minimum":13936.89,"maximum":48059.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34586,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34586,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48059.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36045.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36045.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33463.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27595.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37983.95,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14076.26,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14355,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14215.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14285.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13936.89,"methodology":"case rate"}]}]},{"description":"PT","code_information":[{"code":"421","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"MALNUTRITION FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS","code_information":[{"code":"4211","type":"APR-DRG"}],"standard_charges":[{"minimum":3119,"maximum":3119,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3119,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3119,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3119,"methodology":"case rate"}]}]},{"description":"MALNUTRITION FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS","code_information":[{"code":"4212","type":"APR-DRG"}],"standard_charges":[{"minimum":4050,"maximum":4050,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4050,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4050,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4050,"methodology":"case rate"}]}]},{"description":"MALNUTRITION FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS","code_information":[{"code":"4213","type":"APR-DRG"}],"standard_charges":[{"minimum":6530,"maximum":6530,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6530,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6530,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6530,"methodology":"case rate"}]}]},{"description":"MALNUTRITION FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS","code_information":[{"code":"4214","type":"APR-DRG"}],"standard_charges":[{"minimum":14623,"maximum":14623,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14623,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14623,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14623,"methodology":"case rate"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"minimum":12636.2,"maximum":41400.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26383,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26383,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41400.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31050.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31050.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25526.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21050.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28974.83,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12762.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13015.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12888.93,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12952.11,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"}]}]},{"description":"PT","code_information":[{"code":"422","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS","code_information":[{"code":"4221","type":"APR-DRG"}],"standard_charges":[{"minimum":2350,"maximum":2350,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2350,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2350,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2350,"methodology":"case rate"}]}]},{"description":"HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS","code_information":[{"code":"4222","type":"APR-DRG"}],"standard_charges":[{"minimum":3139,"maximum":3139,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3139,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3139,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3139,"methodology":"case rate"}]}]},{"description":"HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS","code_information":[{"code":"4223","type":"APR-DRG"}],"standard_charges":[{"minimum":4780,"maximum":4780,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"case rate"}]}]},{"description":"HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS","code_information":[{"code":"4224","type":"APR-DRG"}],"standard_charges":[{"minimum":9598,"maximum":9598,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9598,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9598,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9598,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"minimum":32726.58,"maximum":87434.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79614,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79614,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80011.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60009.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60009.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":77029.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63522.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":87434.06,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32726.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":33053.85,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33708.38,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33381.12,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32726.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32726.58,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32726.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33544.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32726.58,"methodology":"case rate"}]}]},{"description":"PT","code_information":[{"code":"423","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"INBORN ERRORS OF METABOLISM","code_information":[{"code":"4231","type":"APR-DRG"}],"standard_charges":[{"minimum":3728,"maximum":3728,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3728,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3728,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3728,"methodology":"case rate"}]}]},{"description":"INBORN ERRORS OF METABOLISM","code_information":[{"code":"4232","type":"APR-DRG"}],"standard_charges":[{"minimum":5424,"maximum":5424,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5424,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5424,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5424,"methodology":"case rate"}]}]},{"description":"INBORN ERRORS OF METABOLISM","code_information":[{"code":"4233","type":"APR-DRG"}],"standard_charges":[{"minimum":8209,"maximum":8209,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8209,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8209,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8209,"methodology":"case rate"}]}]},{"description":"INBORN ERRORS OF METABOLISM","code_information":[{"code":"4234","type":"APR-DRG"}],"standard_charges":[{"minimum":19242,"maximum":19242,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19242,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19242,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"minimum":18930.1,"maximum":60837.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42292,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42292,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60837.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45628.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45628.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":40919.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":33743.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46446.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18930.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19119.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19498.01,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19308.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18930.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18930.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18930.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19403.36,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18930.1,"methodology":"case rate"}]}]},{"description":"PT","code_information":[{"code":"424","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE DISORDERS","code_information":[{"code":"4241","type":"APR-DRG"}],"standard_charges":[{"minimum":3403,"maximum":3403,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3403,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3403,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3403,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE DISORDERS","code_information":[{"code":"4242","type":"APR-DRG"}],"standard_charges":[{"minimum":4544,"maximum":4544,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4544,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4544,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4544,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE DISORDERS","code_information":[{"code":"4243","type":"APR-DRG"}],"standard_charges":[{"minimum":6756,"maximum":6756,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6756,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6756,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6756,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE DISORDERS","code_information":[{"code":"4244","type":"APR-DRG"}],"standard_charges":[{"minimum":12933,"maximum":12933,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12933,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12933,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12933,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"minimum":13227,"maximum":52160.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27454,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27454,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52160.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39121.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39121.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26562.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21904.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30150.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13227,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13359.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13623.81,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13491.54,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13227,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13227,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13227,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13557.68,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13227,"methodology":"case rate"}]}]},{"description":"OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS","code_information":[{"code":"4251","type":"APR-DRG"}],"standard_charges":[{"minimum":2754,"maximum":2754,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2754,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2754,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2754,"methodology":"case rate"}]}]},{"description":"OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS","code_information":[{"code":"4252","type":"APR-DRG"}],"standard_charges":[{"minimum":3496,"maximum":3496,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3496,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3496,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3496,"methodology":"case rate"}]}]},{"description":"OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS","code_information":[{"code":"4253","type":"APR-DRG"}],"standard_charges":[{"minimum":4925,"maximum":4925,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4925,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4925,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4925,"methodology":"case rate"}]}]},{"description":"OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS","code_information":[{"code":"4254","type":"APR-DRG"}],"standard_charges":[{"minimum":10403,"maximum":10403,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10403,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10403,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10403,"methodology":"case rate"}]}]},{"description":"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"minimum":82279.77,"maximum":173240.35,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173240.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":129932.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":129932.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":82279.77,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":83102.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":84748.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":83925.37,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":82279.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":82279.77,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":82279.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":84336.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":82279.77,"methodology":"case rate"}]}]},{"description":"NON-HYPOVOLEMIC SODIUM DISORDERS","code_information":[{"code":"4261","type":"APR-DRG"}],"standard_charges":[{"minimum":2863,"maximum":2863,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2863,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2863,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2863,"methodology":"case rate"}]}]},{"description":"NON-HYPOVOLEMIC SODIUM DISORDERS","code_information":[{"code":"4262","type":"APR-DRG"}],"standard_charges":[{"minimum":3800,"maximum":3800,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3800,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3800,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3800,"methodology":"case rate"}]}]},{"description":"NON-HYPOVOLEMIC SODIUM DISORDERS","code_information":[{"code":"4263","type":"APR-DRG"}],"standard_charges":[{"minimum":5772,"maximum":5772,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5772,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5772,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5772,"methodology":"case rate"}]}]},{"description":"NON-HYPOVOLEMIC SODIUM DISORDERS","code_information":[{"code":"4264","type":"APR-DRG"}],"standard_charges":[{"minimum":11448,"maximum":11448,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11448,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11448,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11448,"methodology":"case rate"}]}]},{"description":"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"minimum":56198.61,"maximum":160306.6,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160306.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":120232.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":120232.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56198.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":56760.6,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":57884.57,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":57322.59,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56198.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56198.61,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56198.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":57603.58,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56198.61,"methodology":"case rate"}]}]},{"description":"THYROID DISORDERS","code_information":[{"code":"4271","type":"APR-DRG"}],"standard_charges":[{"minimum":3145,"maximum":3145,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145,"methodology":"case rate"}]}]},{"description":"THYROID DISORDERS","code_information":[{"code":"4272","type":"APR-DRG"}],"standard_charges":[{"minimum":4308,"maximum":4308,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4308,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4308,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4308,"methodology":"case rate"}]}]},{"description":"THYROID DISORDERS","code_information":[{"code":"4273","type":"APR-DRG"}],"standard_charges":[{"minimum":6910,"maximum":6910,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6910,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6910,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6910,"methodology":"case rate"}]}]},{"description":"THYROID DISORDERS","code_information":[{"code":"4274","type":"APR-DRG"}],"standard_charges":[{"minimum":12842,"maximum":12842,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12842,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12842,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12842,"methodology":"case rate"}]}]},{"description":"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"minimum":43836.61,"maximum":138900.31,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138900.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":104177.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":104177.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":43836.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":44274.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":45151.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":44713.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":43836.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":43836.61,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":43836.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44932.53,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":43836.61,"methodology":"case rate"}]}]},{"description":"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"minimum":65771.32,"maximum":153332.68,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153332.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":115001.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":115001.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":65771.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":66429.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":67744.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":67086.75,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":65771.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":65771.32,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":65771.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":67415.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":65771.32,"methodology":"case rate"}]}]},{"description":"PT","code_information":[{"code":"429","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"minimum":43576.78,"maximum":138900.31,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138900.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":104177.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":104177.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":43576.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":44012.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44884.09,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":44448.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":43576.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":43576.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":43576.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44666.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":43576.78,"methodology":"case rate"}]}]},{"description":"OT","code_information":[{"code":"430","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"OT","code_information":[{"code":"431","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"minimum":16423.06,"maximum":37616.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34252,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34252,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35194.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26396.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26396.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33140.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27329.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37616.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16423.06,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16587.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16915.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16751.53,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16423.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16423.06,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16423.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16833.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16423.06,"methodology":"case rate"}]}]},{"description":"OT","code_information":[{"code":"432","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"minimum":9546.08,"maximum":26763.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19386,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19386,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26763.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20073.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20073.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18756.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15467.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21290.16,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9546.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9641.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9832.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9737.01,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9546.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9546.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9546.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9784.74,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9546.08,"methodology":"case rate"}]}]},{"description":"OT","code_information":[{"code":"433","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"minimum":6659.35,"maximum":23704.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12020,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12020,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23704.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17778.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17778.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11630.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9590.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13201.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6659.35,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6725.95,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6859.14,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6792.54,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6659.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6659.35,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6659.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6825.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6659.35,"methodology":"case rate"}]}]},{"description":"OT","code_information":[{"code":"434","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"minimum":15382.97,"maximum":35011.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31880,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31880,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31803.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23852.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23852.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30844.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25436.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35011.17,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15382.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15536.8,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15844.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15690.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15382.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15382.97,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15382.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15767.55,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15382.97,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"minimum":9993.83,"maximum":26206.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21146,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21146,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26206.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19655.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19655.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20459.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16871.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23223.19,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9993.83,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10093.77,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10293.65,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10193.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9993.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9993.83,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9993.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10243.68,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9993.83,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"minimum":7345.27,"maximum":23777.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16491,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16491,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23777.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17833.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17833.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15955.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13157.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18111.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7345.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7418.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7565.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7492.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7345.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7345.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7345.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7528.91,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7345.27,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"minimum":14138.72,"maximum":34924.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30775,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30775,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34924.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26194.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26194.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29776.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24554.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33798.12,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14138.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14280.11,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14562.89,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14421.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14138.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14138.72,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14138.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14492.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14138.72,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":7925.24,"maximum":23718.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15914,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15914,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23718.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17789.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17789.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15397.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12697.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17477.73,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7925.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8004.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8163,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8083.75,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7925.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7925.24,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7925.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8123.38,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7925.24,"methodology":"case rate"}]}]},{"description":"OT","code_information":[{"code":"439","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":6029.88,"maximum":19924.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11564,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11564,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19924.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14944.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14944.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11188.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9226.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12699.82,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6029.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6090.18,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6210.78,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6150.48,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6029.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6029.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6029.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6180.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6029.88,"methodology":"case rate"}]}]},{"description":"SPEECH THERAPY","code_information":[{"code":"440","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"4401","type":"APR-DRG"}],"standard_charges":[{"minimum":29256,"maximum":29256,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29256,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29256,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29256,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"4402","type":"APR-DRG"}],"standard_charges":[{"minimum":31097,"maximum":31097,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31097,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31097,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31097,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"4403","type":"APR-DRG"}],"standard_charges":[{"minimum":36063,"maximum":36063,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36063,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36063,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36063,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"4404","type":"APR-DRG"}],"standard_charges":[{"minimum":55507,"maximum":55507,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55507,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55507,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55507,"methodology":"case rate"}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"minimum":15891.8,"maximum":38175.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34761,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34761,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30442.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22832.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22832.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33632.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27735.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38175.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15891.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16050.72,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16368.56,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16209.64,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15891.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15891.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15891.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16289.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15891.8,"methodology":"case rate"}]}]},{"description":"SPEECH THERAPY","code_information":[{"code":"441","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES","code_information":[{"code":"4411","type":"APR-DRG"}],"standard_charges":[{"minimum":9486,"maximum":9486,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9486,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9486,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES","code_information":[{"code":"4412","type":"APR-DRG"}],"standard_charges":[{"minimum":14023,"maximum":14023,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14023,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14023,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14023,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES","code_information":[{"code":"4413","type":"APR-DRG"}],"standard_charges":[{"minimum":17986,"maximum":17986,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17986,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17986,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17986,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES","code_information":[{"code":"4414","type":"APR-DRG"}],"standard_charges":[{"minimum":37382,"maximum":37382,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37382,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37382,"methodology":"case rate"}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"minimum":8744.94,"maximum":23825.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17533,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17533,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23825.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17869.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17869.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16964.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13989.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19256.04,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8744.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8832.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9007.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8919.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8744.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8744.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8744.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8963.57,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8744.94,"methodology":"case rate"}]}]},{"description":"SPEECH THERAPY","code_information":[{"code":"442","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY","code_information":[{"code":"4421","type":"APR-DRG"}],"standard_charges":[{"minimum":8478,"maximum":8478,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8478,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8478,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8478,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY","code_information":[{"code":"4422","type":"APR-DRG"}],"standard_charges":[{"minimum":9707,"maximum":9707,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9707,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9707,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9707,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY","code_information":[{"code":"4423","type":"APR-DRG"}],"standard_charges":[{"minimum":14992,"maximum":14992,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14992,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14992,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14992,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY","code_information":[{"code":"4424","type":"APR-DRG"}],"standard_charges":[{"minimum":26261,"maximum":26261,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26261,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26261,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26261,"methodology":"case rate"}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"minimum":6707.29,"maximum":19779.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12779,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12779,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19779.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14835,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14835,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12364.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10196.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14034.58,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6774.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6908.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6841.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6874.98,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.29,"methodology":"case rate"}]}]},{"description":"SPEECH THERAPY","code_information":[{"code":"443","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY","code_information":[{"code":"4431","type":"APR-DRG"}],"standard_charges":[{"minimum":7500,"maximum":7500,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7500,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7500,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7500,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY","code_information":[{"code":"4432","type":"APR-DRG"}],"standard_charges":[{"minimum":8747,"maximum":8747,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8747,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY","code_information":[{"code":"4433","type":"APR-DRG"}],"standard_charges":[{"minimum":13663,"maximum":13663,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13663,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13663,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13663,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY","code_information":[{"code":"4434","type":"APR-DRG"}],"standard_charges":[{"minimum":25616,"maximum":25616,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25616,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25616,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25616,"methodology":"case rate"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITH MCC","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"minimum":14298.8,"maximum":33546.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30546,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30546,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25462.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19097.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19097.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29554.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24371.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33546.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14298.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14441.79,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14727.77,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14584.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14298.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14298.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14298.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14656.27,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14298.8,"methodology":"case rate"}]}]},{"description":"SPEECH THERAPY","code_information":[{"code":"444","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"RENAL DIALYSIS ACCESS DEVICE PROCEDURES AND VESSEL REPAIR","code_information":[{"code":"4441","type":"APR-DRG"}],"standard_charges":[{"minimum":6496,"maximum":6496,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6496,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6496,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6496,"methodology":"case rate"}]}]},{"description":"RENAL DIALYSIS ACCESS DEVICE PROCEDURES AND VESSEL REPAIR","code_information":[{"code":"4442","type":"APR-DRG"}],"standard_charges":[{"minimum":9922,"maximum":9922,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9922,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9922,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9922,"methodology":"case rate"}]}]},{"description":"RENAL DIALYSIS ACCESS DEVICE PROCEDURES AND VESSEL REPAIR","code_information":[{"code":"4443","type":"APR-DRG"}],"standard_charges":[{"minimum":15823,"maximum":15823,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15823,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15823,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15823,"methodology":"case rate"}]}]},{"description":"RENAL DIALYSIS ACCESS DEVICE PROCEDURES AND VESSEL REPAIR","code_information":[{"code":"4444","type":"APR-DRG"}],"standard_charges":[{"minimum":28355,"maximum":28355,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28355,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28355,"methodology":"case rate"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITH CC","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"minimum":9659.76,"maximum":22166.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20184,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20184,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20437.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15328.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15328.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19529.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16104.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22166.93,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9659.76,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9756.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9949.56,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9852.96,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9659.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9659.76,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9659.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9901.26,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9659.76,"methodology":"case rate"}]}]},{"description":"OTHER BLADDER PROCEDURES","code_information":[{"code":"4451","type":"APR-DRG"}],"standard_charges":[{"minimum":6097,"maximum":6097,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6097,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6097,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6097,"methodology":"case rate"}]}]},{"description":"OTHER BLADDER PROCEDURES","code_information":[{"code":"4452","type":"APR-DRG"}],"standard_charges":[{"minimum":7913,"maximum":7913,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7913,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7913,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7913,"methodology":"case rate"}]}]},{"description":"OTHER BLADDER PROCEDURES","code_information":[{"code":"4453","type":"APR-DRG"}],"standard_charges":[{"minimum":11363,"maximum":11363,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11363,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11363,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11363,"methodology":"case rate"}]}]},{"description":"OTHER BLADDER PROCEDURES","code_information":[{"code":"4454","type":"APR-DRG"}],"standard_charges":[{"minimum":23072,"maximum":23072,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23072,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23072,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23072,"methodology":"case rate"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"minimum":7438.84,"maximum":16766,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15266,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15266,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15785.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11839.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11839.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14770.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12180.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16766,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7438.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7513.23,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7662.01,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7438.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7438.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7438.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7624.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7438.84,"methodology":"case rate"}]}]},{"description":"URETHRAL AND TRANSURETHRAL PROCEDURES","code_information":[{"code":"4461","type":"APR-DRG"}],"standard_charges":[{"minimum":5132,"maximum":5132,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5132,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5132,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5132,"methodology":"case rate"}]}]},{"description":"URETHRAL AND TRANSURETHRAL PROCEDURES","code_information":[{"code":"4462","type":"APR-DRG"}],"standard_charges":[{"minimum":6340,"maximum":6340,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6340,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6340,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6340,"methodology":"case rate"}]}]},{"description":"URETHRAL AND TRANSURETHRAL PROCEDURES","code_information":[{"code":"4463","type":"APR-DRG"}],"standard_charges":[{"minimum":10665,"maximum":10665,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10665,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10665,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10665,"methodology":"case rate"}]}]},{"description":"URETHRAL AND TRANSURETHRAL PROCEDURES","code_information":[{"code":"4464","type":"APR-DRG"}],"standard_charges":[{"minimum":19262,"maximum":19262,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19262,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19262,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19262,"methodology":"case rate"}]}]},{"description":"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"minimum":53120.87,"maximum":103736.55,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103736.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77803.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77803.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":53120.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":53652.08,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":54714.5,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":54183.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":53120.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":53120.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":53120.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":54448.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":53120.87,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY URINARY TRACT AND RELATED PROCEDURES","code_information":[{"code":"4471","type":"APR-DRG"}],"standard_charges":[{"minimum":8814,"maximum":8814,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8814,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8814,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8814,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY URINARY TRACT AND RELATED PROCEDURES","code_information":[{"code":"4472","type":"APR-DRG"}],"standard_charges":[{"minimum":9498,"maximum":9498,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9498,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9498,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9498,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY URINARY TRACT AND RELATED PROCEDURES","code_information":[{"code":"4473","type":"APR-DRG"}],"standard_charges":[{"minimum":13747,"maximum":13747,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13747,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13747,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13747,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY URINARY TRACT AND RELATED PROCEDURES","code_information":[{"code":"4474","type":"APR-DRG"}],"standard_charges":[{"minimum":31011,"maximum":31011,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31011,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31011,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31011,"methodology":"case rate"}]}]},{"description":"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"minimum":32851.08,"maximum":74307.67,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74307.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55731.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55731.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32851.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":33179.6,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33836.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33508.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32851.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32851.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32851.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33672.36,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32851.08,"methodology":"case rate"}]}]},{"description":"SPEECH THERAPY","code_information":[{"code":"449","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":373,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":373,"methodology":"case rate"}]}]},{"description":"EMERGENCY ROOM - GENERAL","code_information":[{"code":"450","type":"RC"}],"standard_charges":[{"minimum":444.9,"maximum":1242,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1037,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1237,"methodology":"case rate"}]}]},{"description":"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"minimum":41099.12,"maximum":101351.92,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101351.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76015.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76015.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41099.12,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":41510.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":42332.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":41921.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41099.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41099.12,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41099.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42126.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41099.12,"methodology":"case rate"}]}]},{"description":"LACERATION REPAIR LEVEL 1","code_information":[{"code":"4501000006","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":340.79,"maximum":525.34,"gross_charge":643,"discounted_cash":147.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":340.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"}]}]},{"description":"LACERATION REPAIR LEVEL 1","code_information":[{"code":"4501000006","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":340.79,"maximum":525.34,"gross_charge":643,"discounted_cash":147.25,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":340.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":525.34,"methodology":"fee schedule"}]}]},{"description":"LACERATION REPAIR LEVEL 2","code_information":[{"code":"4501000007","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1046.75,"maximum":1613.58,"gross_charge":1975,"discounted_cash":452.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1046.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1613.58,"methodology":"fee schedule"}]}]},{"description":"LACERATION REPAIR LEVEL 2","code_information":[{"code":"4501000007","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1046.75,"maximum":1613.58,"gross_charge":1975,"discounted_cash":452.28,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1046.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1613.58,"methodology":"fee schedule"}]}]},{"description":"LACERATION REPAIR LEVEL 3","code_information":[{"code":"4501000008","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1732.04,"maximum":2669.96,"gross_charge":3268,"discounted_cash":748.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1732.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2669.96,"methodology":"fee schedule"}]}]},{"description":"LACERATION REPAIR LEVEL 3","code_information":[{"code":"4501000008","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1732.04,"maximum":2669.96,"gross_charge":3268,"discounted_cash":748.38,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1732.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2669.96,"methodology":"fee schedule"}]}]},{"description":"LACERATION REPAIR LVL2 ADD<5CM","code_information":[{"code":"4501000009","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":660.91,"maximum":1018.8,"gross_charge":1247,"discounted_cash":285.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":660.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1018.8,"methodology":"fee schedule"}]}]},{"description":"LACERATION REPAIR LVL2 ADD<5CM","code_information":[{"code":"4501000009","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":660.91,"maximum":1018.8,"gross_charge":1247,"discounted_cash":285.57,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":660.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1018.8,"methodology":"fee schedule"}]}]},{"description":"REM FB/SKN LES IMP LVL 1","code_information":[{"code":"4501000010","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":271.36,"maximum":418.31,"gross_charge":512,"discounted_cash":117.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":271.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":418.31,"methodology":"fee schedule"}]}]},{"description":"REM FB/SKN LES IMP LVL 1","code_information":[{"code":"4501000010","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":271.36,"maximum":418.31,"gross_charge":512,"discounted_cash":117.25,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":271.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":418.31,"methodology":"fee schedule"}]}]},{"description":"REMOVE FB/IMPLANT LEVEL 3","code_information":[{"code":"4501000011","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4286.64,"maximum":6607.9,"gross_charge":8088,"discounted_cash":1852.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4286.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6607.9,"methodology":"fee schedule"}]}]},{"description":"REMOVE FB/IMPLANT LEVEL 3","code_information":[{"code":"4501000011","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4286.64,"maximum":6607.9,"gross_charge":8088,"discounted_cash":1852.16,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4286.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6607.9,"methodology":"fee schedule"}]}]},{"description":"INCISION/DRAINAGE/ASP LEVEL 3","code_information":[{"code":"4501000013","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4163.15,"maximum":6417.54,"gross_charge":7855,"discounted_cash":1798.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4163.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6417.54,"methodology":"fee schedule"}]}]},{"description":"INCISION/DRAINAGE/ASP LEVEL 3","code_information":[{"code":"4501000013","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4163.15,"maximum":6417.54,"gross_charge":7855,"discounted_cash":1798.8,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4163.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6417.54,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE SKIN/SUBQ/MUS","code_information":[{"code":"4501000014","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1631.87,"maximum":2515.55,"gross_charge":3079,"discounted_cash":705.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1631.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2515.55,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE SKIN/SUBQ/MUS","code_information":[{"code":"4501000014","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1631.87,"maximum":2515.55,"gross_charge":3079,"discounted_cash":705.1,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1631.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2515.55,"methodology":"fee schedule"}]}]},{"description":"DRESS/DEBRIDE BURN","code_information":[{"code":"4501000015","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":302.1,"maximum":465.69,"gross_charge":570,"discounted_cash":130.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.69,"methodology":"fee schedule"}]}]},{"description":"DRESS/DEBRIDE BURN","code_information":[{"code":"4501000015","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":302.1,"maximum":465.69,"gross_charge":570,"discounted_cash":130.53,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.69,"methodology":"fee schedule"}]}]},{"description":"TX FX/DISLOC LEVEL 1","code_information":[{"code":"4501000016","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":400.15,"maximum":616.84,"gross_charge":755,"discounted_cash":172.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":400.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":616.84,"methodology":"fee schedule"}]}]},{"description":"TX FX/DISLOC LEVEL 1","code_information":[{"code":"4501000016","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":400.15,"maximum":616.84,"gross_charge":755,"discounted_cash":172.9,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":400.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":616.84,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF CAST","code_information":[{"code":"4501000017","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":254.93,"maximum":392.98,"gross_charge":481,"discounted_cash":110.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.98,"methodology":"fee schedule"}]}]},{"description":"APPLICATION OF CAST","code_information":[{"code":"4501000017","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":254.93,"maximum":392.98,"gross_charge":481,"discounted_cash":110.15,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":254.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.98,"methodology":"fee schedule"}]}]},{"description":"STRAPPING","code_information":[{"code":"4501000019","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":165.89,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"}]}]},{"description":"STRAPPING","code_information":[{"code":"4501000019","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":165.89,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"}]}]},{"description":"WINDOWING/WEDGING OF CAST","code_information":[{"code":"4501000020","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":583,"maximum":898.7,"gross_charge":1100,"discounted_cash":251.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":583,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":898.7,"methodology":"fee schedule"}]}]},{"description":"WINDOWING/WEDGING OF CAST","code_information":[{"code":"4501000020","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":583,"maximum":898.7,"gross_charge":1100,"discounted_cash":251.9,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":583,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":898.7,"methodology":"fee schedule"}]}]},{"description":"CAUT/CNTRL BLEED LEVEL 1","code_information":[{"code":"4501000021","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":301.04,"maximum":464.06,"gross_charge":568,"discounted_cash":130.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":301.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":464.06,"methodology":"fee schedule"}]}]},{"description":"CAUT/CNTRL BLEED LEVEL 1","code_information":[{"code":"4501000021","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":301.04,"maximum":464.06,"gross_charge":568,"discounted_cash":130.08,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":301.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":464.06,"methodology":"fee schedule"}]}]},{"description":"INS/REPL TEMP PACER ELECTRODE","code_information":[{"code":"4501000023","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":11747.98,"maximum":18109.63,"gross_charge":22166,"discounted_cash":5076.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11747.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18109.63,"methodology":"fee schedule"}]}]},{"description":"INS/REPL TEMP PACER ELECTRODE","code_information":[{"code":"4501000023","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":11747.98,"maximum":18109.63,"gross_charge":22166,"discounted_cash":5076.02,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11747.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18109.63,"methodology":"fee schedule"}]}]},{"description":"HEMORRHOID EXC/INC SIMPLE","code_information":[{"code":"4501000024","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2717.31,"maximum":4188.76,"gross_charge":5127,"discounted_cash":1174.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2717.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4188.76,"methodology":"fee schedule"}]}]},{"description":"HEMORRHOID EXC/INC SIMPLE","code_information":[{"code":"4501000024","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2717.31,"maximum":4188.76,"gross_charge":5127,"discounted_cash":1174.09,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2717.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4188.76,"methodology":"fee schedule"}]}]},{"description":"LUMBAR/SHUNT PUNCTURE","code_information":[{"code":"4501000026","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1054.17,"maximum":1625.02,"gross_charge":1989,"discounted_cash":455.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1054.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1625.02,"methodology":"fee schedule"}]}]},{"description":"LUMBAR/SHUNT PUNCTURE","code_information":[{"code":"4501000026","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1054.17,"maximum":1625.02,"gross_charge":1989,"discounted_cash":455.49,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1054.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1625.02,"methodology":"fee schedule"}]}]},{"description":"CV CATH/PICC LEVEL 2","code_information":[{"code":"4501000027","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":6121.5,"maximum":9436.35,"gross_charge":11550,"discounted_cash":2644.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6121.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9436.35,"methodology":"fee schedule"}]}]},{"description":"CV CATH/PICC LEVEL 2","code_information":[{"code":"4501000027","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":6121.5,"maximum":9436.35,"gross_charge":11550,"discounted_cash":2644.95,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6121.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9436.35,"methodology":"fee schedule"}]}]},{"description":"CV CATH/PICC LEVEL 1","code_information":[{"code":"4501000028","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2405.67,"maximum":3708.37,"gross_charge":4539,"discounted_cash":1039.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2405.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3708.37,"methodology":"fee schedule"}]}]},{"description":"CV CATH/PICC LEVEL 1","code_information":[{"code":"4501000028","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2405.67,"maximum":3708.37,"gross_charge":4539,"discounted_cash":1039.44,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2405.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3708.37,"methodology":"fee schedule"}]}]},{"description":"DEBRID/AVUL NAIL EVAC HEM","code_information":[{"code":"4501000029","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":141.51,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"}]}]},{"description":"DEBRID/AVUL NAIL EVAC HEM","code_information":[{"code":"4501000029","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":141.51,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"}]}]},{"description":"EXCISE/REPAIR NAIL","code_information":[{"code":"4501000030","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"EXCISE/REPAIR NAIL","code_information":[{"code":"4501000030","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE OPEN FX W FB REMOV","code_information":[{"code":"4501000031","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1163.88,"maximum":1794.14,"gross_charge":2196,"discounted_cash":502.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1163.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1794.14,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE OPEN FX W FB REMOV","code_information":[{"code":"4501000031","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1163.88,"maximum":1794.14,"gross_charge":2196,"discounted_cash":502.89,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1163.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1794.14,"methodology":"fee schedule"}]}]},{"description":"TX FX/DISLOC LEVEL 2","code_information":[{"code":"4501000032","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1205.22,"maximum":1857.86,"gross_charge":2274,"discounted_cash":520.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1205.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1857.86,"methodology":"fee schedule"}]}]},{"description":"TX FX/DISLOC LEVEL 2","code_information":[{"code":"4501000032","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1205.22,"maximum":1857.86,"gross_charge":2274,"discounted_cash":520.75,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1205.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1857.86,"methodology":"fee schedule"}]}]},{"description":"TX FX/DISLOC LEVEL 3","code_information":[{"code":"4501000033","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4784.84,"maximum":7375.88,"gross_charge":9028,"discounted_cash":2067.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4784.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7375.88,"methodology":"fee schedule"}]}]},{"description":"TX FX/DISLOC LEVEL 3","code_information":[{"code":"4501000033","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4784.84,"maximum":7375.88,"gross_charge":9028,"discounted_cash":2067.42,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4784.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7375.88,"methodology":"fee schedule"}]}]},{"description":"TX DISLOC LEVEL 3 W ANES","code_information":[{"code":"4501000034","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3626.79,"maximum":5590.74,"gross_charge":6843,"discounted_cash":1567.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3626.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5590.74,"methodology":"fee schedule"}]}]},{"description":"TX DISLOC LEVEL 3 W ANES","code_information":[{"code":"4501000034","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3626.79,"maximum":5590.74,"gross_charge":6843,"discounted_cash":1567.05,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3626.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5590.74,"methodology":"fee schedule"}]}]},{"description":"OB/GYN PROCEDURE LEVEL 3","code_information":[{"code":"4501000035","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4380.45,"maximum":6752.51,"gross_charge":8265,"discounted_cash":1892.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4380.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6752.51,"methodology":"fee schedule"}]}]},{"description":"OB/GYN PROCEDURE LEVEL 3","code_information":[{"code":"4501000035","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4380.45,"maximum":6752.51,"gross_charge":8265,"discounted_cash":1892.69,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4380.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6752.51,"methodology":"fee schedule"}]}]},{"description":"INJ NERVE/OTHR ASP/INJ JOINT","code_information":[{"code":"4501000036","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":616.92,"maximum":950.99,"gross_charge":1164,"discounted_cash":266.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":616.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":950.99,"methodology":"fee schedule"}]}]},{"description":"INJ NERVE/OTHR ASP/INJ JOINT","code_information":[{"code":"4501000036","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":616.92,"maximum":950.99,"gross_charge":1164,"discounted_cash":266.56,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":616.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":950.99,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY EMERGENCY","code_information":[{"code":"4501000038","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1657.31,"maximum":2554.76,"gross_charge":3127,"discounted_cash":716.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1657.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2554.76,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY EMERGENCY","code_information":[{"code":"4501000038","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1657.31,"maximum":2554.76,"gross_charge":3127,"discounted_cash":716.09,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1657.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2554.76,"methodology":"fee schedule"}]}]},{"description":"CLOSE/PACK WND DEHISCEN SMPL","code_information":[{"code":"4501000039","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":830.51,"maximum":1280.24,"gross_charge":1567,"discounted_cash":358.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":830.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1280.24,"methodology":"fee schedule"}]}]},{"description":"CLOSE/PACK WND DEHISCEN SMPL","code_information":[{"code":"4501000039","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":830.51,"maximum":1280.24,"gross_charge":1567,"discounted_cash":358.85,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":830.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1280.24,"methodology":"fee schedule"}]}]},{"description":"CHANGE TUBE SIMPLE","code_information":[{"code":"4501000040","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":468.52,"maximum":722.23,"gross_charge":884,"discounted_cash":202.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":468.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":722.23,"methodology":"fee schedule"}]}]},{"description":"CHANGE TUBE SIMPLE","code_information":[{"code":"4501000040","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":468.52,"maximum":722.23,"gross_charge":884,"discounted_cash":202.44,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":468.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":722.23,"methodology":"fee schedule"}]}]},{"description":"REMOVE FB/IMPLANT LEVEL 2","code_information":[{"code":"4501000041","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1560.85,"maximum":2406.07,"gross_charge":2945,"discounted_cash":674.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1560.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2406.07,"methodology":"fee schedule"}]}]},{"description":"REMOVE FB/IMPLANT LEVEL 2","code_information":[{"code":"4501000041","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1560.85,"maximum":2406.07,"gross_charge":2945,"discounted_cash":674.41,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1560.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2406.07,"methodology":"fee schedule"}]}]},{"description":"CV CATH LEVEL 3","code_information":[{"code":"4501000042","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":8270.12,"maximum":12748.47,"gross_charge":15604,"discounted_cash":3573.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8270.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12748.47,"methodology":"fee schedule"}]}]},{"description":"CV CATH LEVEL 3","code_information":[{"code":"4501000042","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":8270.12,"maximum":12748.47,"gross_charge":15604,"discounted_cash":3573.32,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8270.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12748.47,"methodology":"fee schedule"}]}]},{"description":"REMOVE/BIVALVE/RPR CAST","code_information":[{"code":"4501000043","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":541.13,"maximum":834.16,"gross_charge":1021,"discounted_cash":233.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":541.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":834.16,"methodology":"fee schedule"}]}]},{"description":"REMOVE/BIVALVE/RPR CAST","code_information":[{"code":"4501000043","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":541.13,"maximum":834.16,"gross_charge":1021,"discounted_cash":233.81,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":541.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":834.16,"methodology":"fee schedule"}]}]},{"description":"REMOVE CERUMEN IMPACTED","code_information":[{"code":"4501000044","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":153.7,"maximum":236.93,"gross_charge":290,"discounted_cash":66.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":153.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":236.93,"methodology":"fee schedule"}]}]},{"description":"REMOVE CERUMEN IMPACTED","code_information":[{"code":"4501000044","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":153.7,"maximum":236.93,"gross_charge":290,"discounted_cash":66.41,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":153.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":236.93,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY DIAGNOSTIC","code_information":[{"code":"4501000046","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":266.59,"maximum":410.96,"gross_charge":503,"discounted_cash":115.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.96,"methodology":"fee schedule"}]}]},{"description":"ANOSCOPY DIAGNOSTIC","code_information":[{"code":"4501000046","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":266.59,"maximum":410.96,"gross_charge":503,"discounted_cash":115.19,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.96,"methodology":"fee schedule"}]}]},{"description":"IRRIG/LAVG/INSTL BLADDER/OTHR","code_information":[{"code":"4501000047","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":562.86,"maximum":867.66,"gross_charge":1062,"discounted_cash":243.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":562.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":867.66,"methodology":"fee schedule"}]}]},{"description":"IRRIG/LAVG/INSTL BLADDER/OTHR","code_information":[{"code":"4501000047","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":562.86,"maximum":867.66,"gross_charge":1062,"discounted_cash":243.2,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":562.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":867.66,"methodology":"fee schedule"}]}]},{"description":"CYSTOSTOMY PROCEDURE COMPLEX","code_information":[{"code":"4501000048","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1452.73,"maximum":2239.4,"gross_charge":2741,"discounted_cash":627.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1452.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2239.4,"methodology":"fee schedule"}]}]},{"description":"CYSTOSTOMY PROCEDURE COMPLEX","code_information":[{"code":"4501000048","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1452.73,"maximum":2239.4,"gross_charge":2741,"discounted_cash":627.69,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1452.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2239.4,"methodology":"fee schedule"}]}]},{"description":"INS/REM PERITL CATH/CANN","code_information":[{"code":"4501000049","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3763.53,"maximum":5801.52,"gross_charge":7101,"discounted_cash":1626.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3763.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5801.52,"methodology":"fee schedule"}]}]},{"description":"INS/REM PERITL CATH/CANN","code_information":[{"code":"4501000049","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3763.53,"maximum":5801.52,"gross_charge":7101,"discounted_cash":1626.13,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3763.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5801.52,"methodology":"fee schedule"}]}]},{"description":"PLACE NEEDLE INTRAOSSEO INFUS","code_information":[{"code":"4501000050","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":450.5,"maximum":694.45,"gross_charge":850,"discounted_cash":194.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":450.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":694.45,"methodology":"fee schedule"}]}]},{"description":"PLACE NEEDLE INTRAOSSEO INFUS","code_information":[{"code":"4501000050","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":450.5,"maximum":694.45,"gross_charge":850,"discounted_cash":194.65,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":450.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":694.45,"methodology":"fee schedule"}]}]},{"description":"CURETTAGE NON OB","code_information":[{"code":"4501000051","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1486.12,"maximum":2290.87,"gross_charge":2804,"discounted_cash":642.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1486.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2290.87,"methodology":"fee schedule"}]}]},{"description":"CURETTAGE NON OB","code_information":[{"code":"4501000051","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1486.12,"maximum":2290.87,"gross_charge":2804,"discounted_cash":642.12,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1486.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2290.87,"methodology":"fee schedule"}]}]},{"description":"THORACOTOMY","code_information":[{"code":"4501000053","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4503.41,"maximum":6942.05,"gross_charge":8497,"discounted_cash":1945.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4503.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6942.05,"methodology":"fee schedule"}]}]},{"description":"THORACOTOMY","code_information":[{"code":"4501000053","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4503.41,"maximum":6942.05,"gross_charge":8497,"discounted_cash":1945.82,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4503.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6942.05,"methodology":"fee schedule"}]}]},{"description":"EXPLORE WOUND","code_information":[{"code":"4501000054","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4694.21,"maximum":7236.17,"gross_charge":8857,"discounted_cash":2028.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4694.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7236.17,"methodology":"fee schedule"}]}]},{"description":"EXPLORE WOUND","code_information":[{"code":"4501000054","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":4694.21,"maximum":7236.17,"gross_charge":8857,"discounted_cash":2028.26,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4694.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7236.17,"methodology":"fee schedule"}]}]},{"description":"RECTAL PROCEDURE INTERMED","code_information":[{"code":"4501000055","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1738.4,"maximum":2679.76,"gross_charge":3280,"discounted_cash":751.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1738.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2679.76,"methodology":"fee schedule"}]}]},{"description":"RECTAL PROCEDURE INTERMED","code_information":[{"code":"4501000055","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1738.4,"maximum":2679.76,"gross_charge":3280,"discounted_cash":751.12,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1738.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2679.76,"methodology":"fee schedule"}]}]},{"description":"EXCISION LEVEL 1","code_information":[{"code":"4501000056","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1420.93,"maximum":2190.38,"gross_charge":2681,"discounted_cash":613.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1420.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2190.38,"methodology":"fee schedule"}]}]},{"description":"EXCISION LEVEL 1","code_information":[{"code":"4501000056","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1420.93,"maximum":2190.38,"gross_charge":2681,"discounted_cash":613.95,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1420.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2190.38,"methodology":"fee schedule"}]}]},{"description":"SKIN PROCEDURE COMPLEX","code_information":[{"code":"4501000057","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2826.49,"maximum":4357.07,"gross_charge":5333,"discounted_cash":1221.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2826.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4357.07,"methodology":"fee schedule"}]}]},{"description":"SKIN PROCEDURE COMPLEX","code_information":[{"code":"4501000057","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2826.49,"maximum":4357.07,"gross_charge":5333,"discounted_cash":1221.26,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2826.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4357.07,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY PROC INTERMED","code_information":[{"code":"4501000058","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2076.01,"maximum":3200.19,"gross_charge":3917,"discounted_cash":897,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2076.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3200.19,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY PROC INTERMED","code_information":[{"code":"4501000058","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2076.01,"maximum":3200.19,"gross_charge":3917,"discounted_cash":897,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2076.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3200.19,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY PROC COMPLEX","code_information":[{"code":"4501000059","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2283.77,"maximum":3520.46,"gross_charge":4309,"discounted_cash":986.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2283.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3520.46,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPY PROC COMPLEX","code_information":[{"code":"4501000059","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2283.77,"maximum":3520.46,"gross_charge":4309,"discounted_cash":986.77,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2283.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3520.46,"methodology":"fee schedule"}]}]},{"description":"FORESKIN MANIPULATION","code_information":[{"code":"4501000060","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":570.81,"maximum":879.91,"gross_charge":1077,"discounted_cash":246.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":570.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":879.91,"methodology":"fee schedule"}]}]},{"description":"FORESKIN MANIPULATION","code_information":[{"code":"4501000060","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":570.81,"maximum":879.91,"gross_charge":1077,"discounted_cash":246.64,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":570.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":879.91,"methodology":"fee schedule"}]}]},{"description":"EXCISION LEVEL 2","code_information":[{"code":"4501000061","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2706.71,"maximum":4172.42,"gross_charge":5107,"discounted_cash":1169.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2706.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4172.42,"methodology":"fee schedule"}]}]},{"description":"EXCISION LEVEL 2","code_information":[{"code":"4501000061","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2706.71,"maximum":4172.42,"gross_charge":5107,"discounted_cash":1169.51,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2706.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4172.42,"methodology":"fee schedule"}]}]},{"description":"INCIS/DRAIN/ASP LEVEL 2","code_information":[{"code":"4501000062","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3448.18,"maximum":5315.41,"gross_charge":6506,"discounted_cash":1489.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3448.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5315.41,"methodology":"fee schedule"}]}]},{"description":"INCIS/DRAIN/ASP LEVEL 2","code_information":[{"code":"4501000062","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3448.18,"maximum":5315.41,"gross_charge":6506,"discounted_cash":1489.88,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3448.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5315.41,"methodology":"fee schedule"}]}]},{"description":"DECLOT THROMBOLYSIS","code_information":[{"code":"4501000063","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":746.77,"maximum":1151.16,"gross_charge":1409,"discounted_cash":322.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":746.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1151.16,"methodology":"fee schedule"}]}]},{"description":"DECLOT THROMBOLYSIS","code_information":[{"code":"4501000063","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":746.77,"maximum":1151.16,"gross_charge":1409,"discounted_cash":322.67,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":746.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1151.16,"methodology":"fee schedule"}]}]},{"description":"BLADDER PROCEDURE LEVEL 1","code_information":[{"code":"4501000064","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":390.08,"maximum":601.32,"gross_charge":736,"discounted_cash":168.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":390.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":601.32,"methodology":"fee schedule"}]}]},{"description":"BLADDER PROCEDURE LEVEL 1","code_information":[{"code":"4501000064","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":390.08,"maximum":601.32,"gross_charge":736,"discounted_cash":168.55,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":390.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":601.32,"methodology":"fee schedule"}]}]},{"description":"BLADDER PROCEDURE LEVEL 2","code_information":[{"code":"4501000065","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":465.87,"maximum":718.15,"gross_charge":879,"discounted_cash":201.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":465.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":718.15,"methodology":"fee schedule"}]}]},{"description":"BLADDER PROCEDURE LEVEL 2","code_information":[{"code":"4501000065","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":465.87,"maximum":718.15,"gross_charge":879,"discounted_cash":201.3,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":465.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":718.15,"methodology":"fee schedule"}]}]},{"description":"DENTAL PROC/REIMPLANT","code_information":[{"code":"4501000066","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":263.94,"maximum":406.87,"gross_charge":498,"discounted_cash":114.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":263.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"}]}]},{"description":"DENTAL PROC/REIMPLANT","code_information":[{"code":"4501000066","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":263.94,"maximum":406.87,"gross_charge":498,"discounted_cash":114.05,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":263.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"}]}]},{"description":"GASTR INTB/ASP/LAV PHY SK","code_information":[{"code":"4501000067","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":348.74,"maximum":537.59,"gross_charge":658,"discounted_cash":150.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":348.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":537.59,"methodology":"fee schedule"}]}]},{"description":"GASTR INTB/ASP/LAV PHY SK","code_information":[{"code":"4501000067","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":348.74,"maximum":537.59,"gross_charge":658,"discounted_cash":150.69,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":348.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":537.59,"methodology":"fee schedule"}]}]},{"description":"OB/GYN PROCEDURE LEVEL 1","code_information":[{"code":"4501000068","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":510.92,"maximum":787.59,"gross_charge":964,"discounted_cash":220.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":510.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":787.59,"methodology":"fee schedule"}]}]},{"description":"OB/GYN PROCEDURE LEVEL 1","code_information":[{"code":"4501000068","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":510.92,"maximum":787.59,"gross_charge":964,"discounted_cash":220.76,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":510.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":787.59,"methodology":"fee schedule"}]}]},{"description":"PARACENTESIS/PERIT LAVAGE","code_information":[{"code":"4501000069","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1490.36,"maximum":2297.41,"gross_charge":2812,"discounted_cash":643.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1490.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2297.41,"methodology":"fee schedule"}]}]},{"description":"PARACENTESIS/PERIT LAVAGE","code_information":[{"code":"4501000069","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1490.36,"maximum":2297.41,"gross_charge":2812,"discounted_cash":643.95,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1490.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2297.41,"methodology":"fee schedule"}]}]},{"description":"INS/REM CARDIAC DEVICE","code_information":[{"code":"4501000070","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1973.72,"maximum":3042.51,"gross_charge":3724,"discounted_cash":852.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1973.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3042.51,"methodology":"fee schedule"}]}]},{"description":"INS/REM CARDIAC DEVICE","code_information":[{"code":"4501000070","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1973.72,"maximum":3042.51,"gross_charge":3724,"discounted_cash":852.8,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1973.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3042.51,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY DIAGNOSTIC","code_information":[{"code":"4501000071","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":884.04,"maximum":1362.76,"gross_charge":1668,"discounted_cash":381.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":884.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1362.76,"methodology":"fee schedule"}]}]},{"description":"LARYNGOSCOPY DIAGNOSTIC","code_information":[{"code":"4501000071","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":884.04,"maximum":1362.76,"gross_charge":1668,"discounted_cash":381.98,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":884.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1362.76,"methodology":"fee schedule"}]}]},{"description":"PERICARDIOCENTESIS","code_information":[{"code":"4501000091","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3532.45,"maximum":5445.31,"gross_charge":6665,"discounted_cash":1526.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3532.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5445.31,"methodology":"fee schedule"}]}]},{"description":"PERICARDIOCENTESIS","code_information":[{"code":"4501000091","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3532.45,"maximum":5445.31,"gross_charge":6665,"discounted_cash":1526.29,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3532.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5445.31,"methodology":"fee schedule"}]}]},{"description":"REM SUT AND/OR STAPLES NO ANES","code_information":[{"code":"4501003023","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"REM SUT AND/OR STAPLES NO ANES","code_information":[{"code":"4501003023","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"EMERGENCY ROOM - EMTALA EMERGENCY MEDICAL SCREENING SERVICES","code_information":[{"code":"451","type":"RC"}],"standard_charges":[{"minimum":444.9,"maximum":1242,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1037,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1237,"methodology":"case rate"}]}]},{"description":"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"minimum":25137.4,"maximum":70967.8,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70967.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53226.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53226.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25137.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25388.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25891.53,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25640.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25137.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25137.4,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25137.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25765.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25137.4,"methodology":"case rate"}]}]},{"description":"EMERGENCY ROOM - ER BEYOND EMTALA SCREENING","code_information":[{"code":"452","type":"RC"}],"standard_charges":[{"minimum":444.9,"maximum":1242,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1037,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1237,"methodology":"case rate"}]}]},{"description":"EMERGENCY ROOM - URGENT CARE","code_information":[{"code":"456","type":"RC"}],"standard_charges":[{"minimum":316,"maximum":593.1,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":377,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":316,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":379,"methodology":"case rate"}]}]},{"description":"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE MALIGNANCY INFECTION OR EXTENSIVE FUSIONS WITH MCC","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"minimum":66765.79,"maximum":187345.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170590,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170590,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144268.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":108203.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":108203.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":165050.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":136109.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":187345.15,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":66765.79,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":67433.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":68768.77,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":68101.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":66765.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":66765.79,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":66765.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":68434.94,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":66765.79,"methodology":"case rate"}]}]},{"description":"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE MALIGNANCY INFECTION OR EXTENSIVE FUSIONS WITH CC","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"minimum":45656.19,"maximum":134369.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122352,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122352,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111849.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":83888.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":83888.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":118379.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97621.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":134369.37,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":45656.19,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":46112.76,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":47025.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":46569.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":45656.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":45656.19,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":45656.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":46797.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":45656.19,"methodology":"case rate"}]}]},{"description":"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE MALIGNANCY INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"minimum":34664.48,"maximum":104342.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88174,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88174,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104342.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78258.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78258.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":85311.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":70352.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":96835.15,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34664.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35011.13,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35704.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35357.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34664.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34664.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34664.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35531.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34664.48,"methodology":"case rate"}]}]},{"description":"EMERGENCY ROOM - OTHER ER","code_information":[{"code":"459","type":"RC"}],"standard_charges":[{"minimum":444.9,"maximum":1237,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":444.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1037,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1237,"methodology":"case rate"}]}]},{"description":"PULMONARY FUNCTION","code_information":[{"code":"460","type":"RC"}],"standard_charges":[{"minimum":741,"maximum":901,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":882,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":741,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":901,"methodology":"case rate"}]}]},{"description":"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"minimum":48728.52,"maximum":119653.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101040,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101040,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119653.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":89742,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":89742,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":97759.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":80617.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":110964.64,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":48728.52,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49215.81,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50190.38,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":49703.1,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":48728.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":48728.52,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":48728.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":49946.74,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":48728.52,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT MALIGNANCY","code_information":[{"code":"4611","type":"APR-DRG"}],"standard_charges":[{"minimum":4810,"maximum":4810,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4810,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4810,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4810,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT MALIGNANCY","code_information":[{"code":"4612","type":"APR-DRG"}],"standard_charges":[{"minimum":5276,"maximum":5276,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5276,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5276,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT MALIGNANCY","code_information":[{"code":"4613","type":"APR-DRG"}],"standard_charges":[{"minimum":8132,"maximum":8132,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8132,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8132,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8132,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT MALIGNANCY","code_information":[{"code":"4614","type":"APR-DRG"}],"standard_charges":[{"minimum":12689,"maximum":12689,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12689,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12689,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12689,"methodology":"case rate"}]}]},{"description":"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"minimum":23419.12,"maximum":96710.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58917,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58917,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96710.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72534.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72534.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":57004.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47008.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64703.93,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23419.12,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23653.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24121.7,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23887.51,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23419.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23419.12,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23419.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24004.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23419.12,"methodology":"case rate"}]}]},{"description":"NEPHRITIS AND NEPHROSIS","code_information":[{"code":"4621","type":"APR-DRG"}],"standard_charges":[{"minimum":3071,"maximum":3071,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3071,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3071,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3071,"methodology":"case rate"}]}]},{"description":"NEPHRITIS AND NEPHROSIS","code_information":[{"code":"4622","type":"APR-DRG"}],"standard_charges":[{"minimum":4442,"maximum":4442,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4442,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4442,"methodology":"case rate"}]}]},{"description":"NEPHRITIS AND NEPHROSIS","code_information":[{"code":"4623","type":"APR-DRG"}],"standard_charges":[{"minimum":9034,"maximum":9034,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9034,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9034,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9034,"methodology":"case rate"}]}]},{"description":"NEPHRITIS AND NEPHROSIS","code_information":[{"code":"4624","type":"APR-DRG"}],"standard_charges":[{"minimum":21045,"maximum":21045,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21045,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21045,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"minimum":43039.34,"maximum":107849.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98204,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98204,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76934.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57702.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57702.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":95015.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":78354.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":107849.51,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":43039.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43469.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44330.53,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43900.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":43039.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":43039.34,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":43039.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44115.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":43039.34,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS","code_information":[{"code":"4631","type":"APR-DRG"}],"standard_charges":[{"minimum":3017,"maximum":3017,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3017,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3017,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3017,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS","code_information":[{"code":"4632","type":"APR-DRG"}],"standard_charges":[{"minimum":3673,"maximum":3673,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3673,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3673,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3673,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS","code_information":[{"code":"4633","type":"APR-DRG"}],"standard_charges":[{"minimum":5063,"maximum":5063,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5063,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5063,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5063,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS","code_information":[{"code":"4634","type":"APR-DRG"}],"standard_charges":[{"minimum":8951,"maximum":8951,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8951,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8951,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8951,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"minimum":24074.88,"maximum":60914.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55466,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55466,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55971.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41979.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41979.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":53665.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":44255.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":60914.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24074.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24315.63,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24797.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24556.38,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24074.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24074.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24074.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24676.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24074.88,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"minimum":14698.59,"maximum":45474.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35977,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35977,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45474.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34106.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34106.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34808.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28705.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39510.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14698.59,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14845.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15139.55,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14992.57,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14698.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14698.59,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14698.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15066.06,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14698.59,"methodology":"case rate"}]}]},{"description":"URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION","code_information":[{"code":"4651","type":"APR-DRG"}],"standard_charges":[{"minimum":3350,"maximum":3350,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3350,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3350,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3350,"methodology":"case rate"}]}]},{"description":"URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION","code_information":[{"code":"4652","type":"APR-DRG"}],"standard_charges":[{"minimum":4068,"maximum":4068,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4068,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4068,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4068,"methodology":"case rate"}]}]},{"description":"URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION","code_information":[{"code":"4653","type":"APR-DRG"}],"standard_charges":[{"minimum":6646,"maximum":6646,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6646,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6646,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6646,"methodology":"case rate"}]}]},{"description":"URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION","code_information":[{"code":"4654","type":"APR-DRG"}],"standard_charges":[{"minimum":11768,"maximum":11768,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11768,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11768,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11768,"methodology":"case rate"}]}]},{"description":"REVISION OF HIP OR KNEE REPLACEMENT WITH MCC","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"minimum":40669.94,"maximum":105194.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91310,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91310,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85922.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":64443.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":64443.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":92676.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":76425.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":105194.43,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":40669.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":41076.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41890.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":41483.34,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":40669.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":40669.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":40669.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":41686.69,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":40669.94,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE","code_information":[{"code":"4661","type":"APR-DRG"}],"standard_charges":[{"minimum":2995,"maximum":2995,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2995,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2995,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2995,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE","code_information":[{"code":"4662","type":"APR-DRG"}],"standard_charges":[{"minimum":4028,"maximum":4028,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4028,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4028,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4028,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE","code_information":[{"code":"4663","type":"APR-DRG"}],"standard_charges":[{"minimum":6162,"maximum":6162,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6162,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6162,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6162,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE","code_information":[{"code":"4664","type":"APR-DRG"}],"standard_charges":[{"minimum":10514,"maximum":10514,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10514,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10514,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10514,"methodology":"case rate"}]}]},{"description":"REVISION OF HIP OR KNEE REPLACEMENT WITH CC","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"minimum":27760.44,"maximum":72454.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59459,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59459,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66790.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50093.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50093.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":63832.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":52639.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":72454.62,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27760.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28038.05,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28593.26,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28315.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27760.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27760.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27760.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28454.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27760.44,"methodology":"case rate"}]}]},{"description":"REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"minimum":21559.33,"maximum":59560.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47109,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47109,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59560.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44671.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44671.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":51109.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":42147.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":58013.62,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21559.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21774.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22206.11,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21990.52,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21559.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21559.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21559.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22098.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21559.33,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES SIGNS AND SYMPTOMS","code_information":[{"code":"4681","type":"APR-DRG"}],"standard_charges":[{"minimum":3313,"maximum":3313,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3313,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3313,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3313,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES SIGNS AND SYMPTOMS","code_information":[{"code":"4682","type":"APR-DRG"}],"standard_charges":[{"minimum":4269,"maximum":4269,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4269,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4269,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4269,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES SIGNS AND SYMPTOMS","code_information":[{"code":"4683","type":"APR-DRG"}],"standard_charges":[{"minimum":6422,"maximum":6422,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6422,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6422,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6422,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES SIGNS AND SYMPTOMS","code_information":[{"code":"4684","type":"APR-DRG"}],"standard_charges":[{"minimum":11190,"maximum":11190,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11190,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11190,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11190,"methodology":"case rate"}]}]},{"description":"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"minimum":26550.22,"maximum":64776.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63090,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63090,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63651.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47739.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47739.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":57067.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47060.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64776.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26550.22,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26815.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27346.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27081.23,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26550.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26550.22,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26550.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27213.98,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26550.22,"methodology":"case rate"}]}]},{"description":"PULMONARY FUNCTION","code_information":[{"code":"469","type":"RC"}],"standard_charges":[{"minimum":741,"maximum":901,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":882,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":741,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":901,"methodology":"case rate"}]}]},{"description":"ACUTE KIDNEY INJURY","code_information":[{"code":"4691","type":"APR-DRG"}],"standard_charges":[{"minimum":2861,"maximum":2861,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2861,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2861,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2861,"methodology":"case rate"}]}]},{"description":"ACUTE KIDNEY INJURY","code_information":[{"code":"4692","type":"APR-DRG"}],"standard_charges":[{"minimum":3872,"maximum":3872,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3872,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3872,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3872,"methodology":"case rate"}]}]},{"description":"ACUTE KIDNEY INJURY","code_information":[{"code":"4693","type":"APR-DRG"}],"standard_charges":[{"minimum":6252,"maximum":6252,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6252,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6252,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6252,"methodology":"case rate"}]}]},{"description":"ACUTE KIDNEY INJURY","code_information":[{"code":"4694","type":"APR-DRG"}],"standard_charges":[{"minimum":12166,"maximum":12166,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12166,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12166,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12166,"methodology":"case rate"}]}]},{"description":"AUDIOLOGY","code_information":[{"code":"470","type":"RC"}],"standard_charges":[{"minimum":204,"maximum":244,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":244,"methodology":"case rate"}]}]},{"description":"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"minimum":15853.91,"maximum":50509.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38249,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38249,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50509.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37883.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37883.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35775.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29502.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40608.09,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.91,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16012.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16329.53,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16170.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.91,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16250.26,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.91,"methodology":"case rate"}]}]},{"description":"CHRONIC KIDNEY DISEASE","code_information":[{"code":"4701","type":"APR-DRG"}],"standard_charges":[{"minimum":3014,"maximum":3014,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3014,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3014,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3014,"methodology":"case rate"}]}]},{"description":"CHRONIC KIDNEY DISEASE","code_information":[{"code":"4702","type":"APR-DRG"}],"standard_charges":[{"minimum":4065,"maximum":4065,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4065,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4065,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4065,"methodology":"case rate"}]}]},{"description":"CHRONIC KIDNEY DISEASE","code_information":[{"code":"4703","type":"APR-DRG"}],"standard_charges":[{"minimum":6019,"maximum":6019,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6019,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6019,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6019,"methodology":"case rate"}]}]},{"description":"CHRONIC KIDNEY DISEASE","code_information":[{"code":"4704","type":"APR-DRG"}],"standard_charges":[{"minimum":11351,"maximum":11351,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11351,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11351,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11351,"methodology":"case rate"}]}]},{"description":"AUDIOLOGY","code_information":[{"code":"471","type":"RC"}],"standard_charges":[{"minimum":204,"maximum":244,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":244,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION WITH MCC","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"minimum":38834.89,"maximum":115535.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110858,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110858,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74027.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55521.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55521.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":90773.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74856.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":115535.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38834.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":39223.24,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39999.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":39611.59,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38834.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38834.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38834.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39805.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38834.89,"methodology":"case rate"}]}]},{"description":"AUDIOLOGY","code_information":[{"code":"472","type":"RC"}],"standard_charges":[{"minimum":204,"maximum":244,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":244,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION WITH CC","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"minimum":23677.4,"maximum":70359.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68076,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68076,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52911.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39684.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39684.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":55279.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":45586,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70359.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23677.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23914.18,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24387.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24150.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23677.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23677.4,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23677.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24269.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23677.4,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION WITHOUT CC/MCC","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"minimum":19580.45,"maximum":58119.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50771,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50771,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41455.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31092.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31092.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45662.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37655.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":58119.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19580.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19776.26,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20167.87,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19972.06,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19580.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19580.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19580.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20069.97,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19580.45,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"minimum":35953.57,"maximum":79939.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72789,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72789,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58961.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44222.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44222.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":70426.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":58077,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":79939.19,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35953.57,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":36313.11,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":37032.18,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":36672.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35953.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35953.57,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35953.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36852.41,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35953.57,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"minimum":17955.74,"maximum":44186.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39467,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39467,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44186.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33140.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33140.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38185.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31489.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43343.63,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17955.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18135.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18494.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18314.86,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17955.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17955.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17955.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18404.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17955.74,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"minimum":10267.57,"maximum":34838.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21878,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21878,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34838.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26129.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26129.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21168.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17456.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24027.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10267.57,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10370.25,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10575.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10472.93,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10267.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10267.57,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10267.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10524.26,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10267.57,"methodology":"case rate"}]}]},{"description":"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"minimum":27867.15,"maximum":73504.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61150,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61150,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58117.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43588.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43588.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":59165.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":48790.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":73504.85,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27867.15,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28145.83,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28703.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28424.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27867.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27867.15,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27867.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28563.83,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27867.15,"methodology":"case rate"}]}]},{"description":"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"minimum":19357.74,"maximum":53601.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43526,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43526,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43411.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32559.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32559.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":42113.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34728.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":53601.47,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19357.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19551.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19938.48,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19744.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19357.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19357.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19357.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19841.69,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19357.74,"methodology":"case rate"}]}]},{"description":"AUDIOLOGY","code_information":[{"code":"479","type":"RC"}],"standard_charges":[{"minimum":204,"maximum":244,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":244,"methodology":"case rate"}]}]},{"description":"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"minimum":15005.59,"maximum":41227.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33478,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33478,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36731.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27549.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27549.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32391.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26711.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41227.63,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15005.59,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15155.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15455.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15305.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15005.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15005.59,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15005.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15380.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15005.59,"methodology":"case rate"}]}]},{"description":"CARDIOLOGY","code_information":[{"code":"480","type":"RC"}],"standard_charges":[{"minimum":1273,"maximum":1542,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1273,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1542,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"minimum":24016.11,"maximum":62271.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56012,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56012,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57833.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43375.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43375.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":54861.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":45241.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":62271.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24016.11,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24256.28,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24736.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24496.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24016.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24016.11,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24016.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24616.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24016.11,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES","code_information":[{"code":"4801","type":"APR-DRG"}],"standard_charges":[{"minimum":7684,"maximum":7684,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7684,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7684,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7684,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES","code_information":[{"code":"4802","type":"APR-DRG"}],"standard_charges":[{"minimum":8617,"maximum":8617,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8617,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8617,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8617,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES","code_information":[{"code":"4803","type":"APR-DRG"}],"standard_charges":[{"minimum":13675,"maximum":13675,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13675,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13675,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13675,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES","code_information":[{"code":"4804","type":"APR-DRG"}],"standard_charges":[{"minimum":30367,"maximum":30367,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30367,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30367,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30367,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"minimum":17318.54,"maximum":44494.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35000,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35000,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44494.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33371.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33371.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37945.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31291.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43071.31,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17318.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17491.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17838.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17664.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17318.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17318.54,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17318.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17751.51,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17318.54,"methodology":"case rate"}]}]},{"description":"CARDIAC STRESS TEST","code_information":[{"code":"482","type":"RC"}],"standard_charges":[{"minimum":881,"maximum":1070,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1051,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":881,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1070,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"minimum":13540.96,"maximum":37655.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28406,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28406,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37655.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28242.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28242.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29903.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24659.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33942.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13540.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13676.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13947.19,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13811.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13540.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13540.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13540.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13879.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13540.96,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY","code_information":[{"code":"4821","type":"APR-DRG"}],"standard_charges":[{"minimum":4769,"maximum":4769,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4769,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4769,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4769,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY","code_information":[{"code":"4822","type":"APR-DRG"}],"standard_charges":[{"minimum":5559,"maximum":5559,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5559,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5559,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5559,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY","code_information":[{"code":"4823","type":"APR-DRG"}],"standard_charges":[{"minimum":11293,"maximum":11293,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11293,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11293,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11293,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY","code_information":[{"code":"4824","type":"APR-DRG"}],"standard_charges":[{"minimum":21200,"maximum":21200,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21200,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21200,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21200,"methodology":"case rate"}]}]},{"description":"ECHOCARDIOLOGY","code_information":[{"code":"483","type":"RC"}],"standard_charges":[{"minimum":617,"maximum":744,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":736,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":617,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":744,"methodology":"case rate"}]}]},{"description":"MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"minimum":20978.58,"maximum":49748.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44935,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44935,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49748.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37312.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37312.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":43476.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":35852.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49349.02,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20978.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21188.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21607.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21398.16,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20978.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20978.58,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20978.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21503.05,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20978.58,"methodology":"case rate"}]}]},{"description":"PENIS TESTES AND SCROTAL PROCEDURES","code_information":[{"code":"4831","type":"APR-DRG"}],"standard_charges":[{"minimum":6742,"maximum":6742,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6742,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6742,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6742,"methodology":"case rate"}]}]},{"description":"PENIS TESTES AND SCROTAL PROCEDURES","code_information":[{"code":"4832","type":"APR-DRG"}],"standard_charges":[{"minimum":8880,"maximum":8880,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8880,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8880,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8880,"methodology":"case rate"}]}]},{"description":"PENIS TESTES AND SCROTAL PROCEDURES","code_information":[{"code":"4833","type":"APR-DRG"}],"standard_charges":[{"minimum":13037,"maximum":13037,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13037,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13037,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13037,"methodology":"case rate"}]}]},{"description":"PENIS TESTES AND SCROTAL PROCEDURES","code_information":[{"code":"4834","type":"APR-DRG"}],"standard_charges":[{"minimum":23482,"maximum":23482,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23482,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23482,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23482,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"4841","type":"APR-DRG"}],"standard_charges":[{"minimum":7441,"maximum":7441,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7441,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7441,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7441,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"4842","type":"APR-DRG"}],"standard_charges":[{"minimum":8387,"maximum":8387,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8387,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8387,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8387,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"4843","type":"APR-DRG"}],"standard_charges":[{"minimum":10177,"maximum":10177,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10177,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10177,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10177,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"4844","type":"APR-DRG"}],"standard_charges":[{"minimum":25707,"maximum":25707,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25707,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25707,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25707,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"minimum":26168.21,"maximum":67645.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61596,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61596,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57262.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42947.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42947.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":59595.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":49145.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":67645.77,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26168.21,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26429.9,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26953.26,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26691.58,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26168.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26168.21,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26168.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26822.42,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26168.21,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"minimum":17674.26,"maximum":45598.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40399,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40399,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45598.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34199.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34199.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39087.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32233.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44366.87,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17674.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17851.01,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18204.49,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18027.75,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17674.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17674.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17674.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18116.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17674.26,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"minimum":13493.02,"maximum":34658.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30191,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30191,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34658.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25994.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25994.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29210.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24088.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33156.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13493.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13627.96,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13897.82,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13762.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13493.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13493.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13493.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13830.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13493.02,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"minimum":16471.78,"maximum":40624.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36991,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36991,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38707.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29031.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29031.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35790.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29514.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40624.59,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16471.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16636.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16965.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16801.22,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16471.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16471.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16471.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16883.58,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16471.78,"methodology":"case rate"}]}]},{"description":"CARDIOLOGY","code_information":[{"code":"489","type":"RC"}],"standard_charges":[{"minimum":1273,"maximum":1542,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1512,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1273,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1542,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"minimum":10849.87,"maximum":32616.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23650,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23650,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32616.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24462.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24462.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22882.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18869.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25973.17,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10849.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10958.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11175.37,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11066.87,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10849.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10849.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10849.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11121.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10849.87,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP FOOT AND FEMUR WITH MCC","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"minimum":28734.8,"maximum":71076.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64719,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64719,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54320.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40741.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40741.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":62618.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":51638.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":71076.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28734.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29022.15,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29596.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29309.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28734.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28734.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28734.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29453.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28734.8,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP FOOT AND FEMUR WITH CC","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"minimum":19840.28,"maximum":47490.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43243,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43243,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40867.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30651.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30651.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":41838.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34502.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47490.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19840.28,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20038.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20435.49,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20237.09,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19840.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19840.28,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19840.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20336.29,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19840.28,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP FOOT AND FEMUR WITHOUT CC/MCC","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"minimum":15853.13,"maximum":37369.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34027,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34027,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30616.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22962.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22962.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32922.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27149.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37369.18,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.13,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16011.67,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16328.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16170.2,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.13,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16249.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.13,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"minimum":28498.17,"maximum":70814.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64481,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64481,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52641.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39482.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39482.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":62387.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":51447.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70814.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28498.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28783.16,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29353.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29068.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28498.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28498.17,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28498.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29210.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28498.17,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"minimum":16530.55,"maximum":42095.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30069,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30069,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36350.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27263.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27263.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37086.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30583.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42095.51,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16530.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16695.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17026.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16861.17,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16530.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16530.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16530.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16943.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16530.55,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"minimum":11655.65,"maximum":30311.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19993,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19993,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25133.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18850.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18850.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26704.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22021.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30311.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11655.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11772.21,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12005.32,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11888.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11655.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11655.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11655.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11947.05,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11655.65,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"minimum":20798.4,"maximum":50504.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45987,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45987,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33654.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25241.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25241.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":44494.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36692.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50504.3,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20798.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21006.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21422.36,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21214.37,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20798.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20798.4,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20798.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21318.36,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20798.4,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"minimum":10249.79,"maximum":23743.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21619,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21619,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22776.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17082.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17082.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20917.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17249.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23743.06,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10249.79,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10352.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10557.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10454.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10249.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10249.79,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10249.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10506.04,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10249.79,"methodology":"case rate"}]}]},{"description":"SOFT TISSUE PROCEDURES WITH MCC","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"minimum":25776.92,"maximum":62203.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56640,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56640,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50419.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37815.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37815.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":54801.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":45191.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":62203.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25776.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26034.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26550.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26292.46,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25776.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25776.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25776.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26421.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25776.92,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM","code_information":[{"code":"5001","type":"APR-DRG"}],"standard_charges":[{"minimum":4050,"maximum":4050,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4050,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4050,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4050,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM","code_information":[{"code":"5002","type":"APR-DRG"}],"standard_charges":[{"minimum":5009,"maximum":5009,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5009,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5009,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5009,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM","code_information":[{"code":"5003","type":"APR-DRG"}],"standard_charges":[{"minimum":7210,"maximum":7210,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7210,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7210,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7210,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM","code_information":[{"code":"5004","type":"APR-DRG"}],"standard_charges":[{"minimum":12712,"maximum":12712,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12712,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12712,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12712,"methodology":"case rate"}]}]},{"description":"SOFT TISSUE PROCEDURES WITH CC","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"minimum":15074.42,"maximum":34617.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31521,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31521,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32640.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24480.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24480.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30497.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25149.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34617.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15074.42,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15225.17,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15526.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15375.91,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15074.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15074.42,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15074.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15451.29,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15074.42,"methodology":"case rate"}]}]},{"description":"MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY","code_information":[{"code":"5011","type":"APR-DRG"}],"standard_charges":[{"minimum":3139,"maximum":3139,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3139,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3139,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3139,"methodology":"case rate"}]}]},{"description":"MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY","code_information":[{"code":"5012","type":"APR-DRG"}],"standard_charges":[{"minimum":4078,"maximum":4078,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4078,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4078,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4078,"methodology":"case rate"}]}]},{"description":"MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY","code_information":[{"code":"5013","type":"APR-DRG"}],"standard_charges":[{"minimum":5975,"maximum":5975,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5975,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5975,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5975,"methodology":"case rate"}]}]},{"description":"MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY","code_information":[{"code":"5014","type":"APR-DRG"}],"standard_charges":[{"minimum":11770,"maximum":11770,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11770,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11770,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11770,"methodology":"case rate"}]}]},{"description":"SOFT TISSUE PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"minimum":12077.87,"maximum":27246.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24809,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24809,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21641.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16231.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16231.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24003.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19794.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27246.04,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12077.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12198.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12440.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12319.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12077.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12077.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12077.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12379.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12077.87,"methodology":"case rate"}]}]},{"description":"FOOT PROCEDURES WITH MCC","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"minimum":21739.51,"maximum":56043.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51031,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51031,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37700.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28276.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28276.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":49374.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":40716.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":56043.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21739.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21956.91,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22391.7,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22174.31,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21739.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21739.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21739.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22283,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21739.51,"methodology":"case rate"}]}]},{"description":"FOOT PROCEDURES WITH CC","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"minimum":14844.75,"maximum":35823.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32620,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32620,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30217.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22663.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22663.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31560.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26026.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35823.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14993.2,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15290.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15141.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15215.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"}]}]},{"description":"FOOT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"minimum":14844.75,"maximum":34689.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31586,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31586,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24901.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18676.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18676.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30561.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25202.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34689.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14993.2,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15290.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15141.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15215.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14844.75,"methodology":"case rate"}]}]},{"description":"MAJOR THUMB OR JOINT PROCEDURES","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"minimum":12865.87,"maximum":27615.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25145,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25145,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23697.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17773.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17773.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24329.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20062.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27615.31,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12994.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13251.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13123.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13187.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12865.87,"methodology":"case rate"}]}]},{"description":"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"minimum":16261.44,"maximum":43323,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39448,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39448,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29401.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22051.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22051.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38167.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31474.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43323,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16261.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16424.06,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16749.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16586.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16261.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16261.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16261.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16667.98,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16261.44,"methodology":"case rate"}]}]},{"description":"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"minimum":11253.53,"maximum":32149.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29274,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29274,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23302.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17477.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17477.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28323.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23357.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32149.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11253.53,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11366.07,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11591.14,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11478.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11253.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11253.53,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11253.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11534.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11253.53,"methodology":"case rate"}]}]},{"description":"ARTHROSCOPY","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"minimum":14857.89,"maximum":40434.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26143,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26143,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40434.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30326.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30326.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25294.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20858.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28710.77,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15006.47,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15303.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15155.05,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"}]}]},{"description":"OUTPATIENT SERVICES - OTHER OUTPATIENT SERVICES","code_information":[{"code":"509","type":"RC"}],"standard_charges":[{"minimum":278.8,"maximum":371.67,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":278.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SHOULDER ELBOW OR FOREARM PROCEDURES EXCEPT MAJOR JOINT PROCEDURES WITH MCC","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"minimum":22835.25,"maximum":57516.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52372,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52372,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30446.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22835.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22835.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":50671.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":41786.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":57516.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23375.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23608.8,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24076.3,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23842.55,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23375.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23375.04,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23375.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23959.42,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23375.04,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES","code_information":[{"code":"5101","type":"APR-DRG"}],"standard_charges":[{"minimum":8211,"maximum":8211,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8211,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8211,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8211,"methodology":"case rate"}]}]},{"description":"DEBR SUBQ TISSUE 1ST 20SQCM","code_information":[{"code":"5101003040","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":772.21,"maximum":1190.37,"gross_charge":1457,"discounted_cash":333.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":772.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1190.37,"methodology":"fee schedule"}]}]},{"description":"DEBR SUBQ TISSUE 1ST 20SQCM","code_information":[{"code":"5101003040","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":552.21,"maximum":1190.37,"gross_charge":1457,"discounted_cash":333.66,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":552.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":552.21,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":772.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1190.37,"methodology":"fee schedule"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES","code_information":[{"code":"5102","type":"APR-DRG"}],"standard_charges":[{"minimum":10417,"maximum":10417,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10417,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10417,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10417,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES","code_information":[{"code":"5103","type":"APR-DRG"}],"standard_charges":[{"minimum":15763,"maximum":15763,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15763,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15763,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15763,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES","code_information":[{"code":"5104","type":"APR-DRG"}],"standard_charges":[{"minimum":32452,"maximum":32452,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32452,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32452,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32452,"methodology":"case rate"}]}]},{"description":"SHOULDER ELBOW OR FOREARM PROCEDURES EXCEPT MAJOR JOINT PROCEDURES WITH CC","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"minimum":16439.3,"maximum":38871.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35394,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35394,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23365.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17524.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17524.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34245.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28240.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38871.04,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16439.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16603.7,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16932.48,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16768.09,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16439.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16439.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16439.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16850.29,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16439.3,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY","code_information":[{"code":"5111","type":"APR-DRG"}],"standard_charges":[{"minimum":8446,"maximum":8446,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8446,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8446,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8446,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY","code_information":[{"code":"5112","type":"APR-DRG"}],"standard_charges":[{"minimum":10104,"maximum":10104,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10104,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10104,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10104,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY","code_information":[{"code":"5113","type":"APR-DRG"}],"standard_charges":[{"minimum":15950,"maximum":15950,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15950,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15950,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15950,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY","code_information":[{"code":"5114","type":"APR-DRG"}],"standard_charges":[{"minimum":29276,"maximum":29276,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29276,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29276,"methodology":"case rate"}]}]},{"description":"SHOULDER ELBOW OR FOREARM PROCEDURES EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"minimum":13706.45,"maximum":31229.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28436,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28436,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24649.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18487.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18487.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27513.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22688.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31229.69,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13706.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13843.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14117.65,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13980.58,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13706.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13706.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13706.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14049.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13706.45,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY","code_information":[{"code":"5121","type":"APR-DRG"}],"standard_charges":[{"minimum":7761,"maximum":7761,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7761,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7761,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7761,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY","code_information":[{"code":"5122","type":"APR-DRG"}],"standard_charges":[{"minimum":9006,"maximum":9006,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9006,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9006,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9006,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY","code_information":[{"code":"5123","type":"APR-DRG"}],"standard_charges":[{"minimum":15211,"maximum":15211,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15211,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15211,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15211,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY","code_information":[{"code":"5124","type":"APR-DRG"}],"standard_charges":[{"minimum":25854,"maximum":25854,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25854,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25854,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25854,"methodology":"case rate"}]}]},{"description":"HAND OR WRIST PROCEDURES EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"minimum":12916.13,"maximum":32535.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29625,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29625,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17439.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13080.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13080.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28663.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23637.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32535.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12916.13,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13045.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13303.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13174.46,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12916.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12916.13,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12916.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13239.04,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12916.13,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA","code_information":[{"code":"5131","type":"APR-DRG"}],"standard_charges":[{"minimum":5717,"maximum":5717,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5717,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5717,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5717,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA","code_information":[{"code":"5132","type":"APR-DRG"}],"standard_charges":[{"minimum":6804,"maximum":6804,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6804,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6804,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6804,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA","code_information":[{"code":"5133","type":"APR-DRG"}],"standard_charges":[{"minimum":11640,"maximum":11640,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11640,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11640,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11640,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA","code_information":[{"code":"5134","type":"APR-DRG"}],"standard_charges":[{"minimum":21445,"maximum":21445,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21445,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21445,"methodology":"case rate"}]}]},{"description":"HAND OR WRIST PROCEDURES EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"minimum":9157.89,"maximum":61574.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20039,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20039,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61574.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46181.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46181.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19389.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15989.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22008.08,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9157.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9249.47,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9432.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9341.05,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9157.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9157.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9157.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9386.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9157.89,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"5141","type":"APR-DRG"}],"standard_charges":[{"minimum":4801,"maximum":4801,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4801,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4801,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4801,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"5142","type":"APR-DRG"}],"standard_charges":[{"minimum":7386,"maximum":7386,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7386,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7386,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7386,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"5143","type":"APR-DRG"}],"standard_charges":[{"minimum":13336,"maximum":13336,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13336,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13336,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13336,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"5144","type":"APR-DRG"}],"standard_charges":[{"minimum":24254,"maximum":24254,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24254,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24254,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24254,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"minimum":25186.89,"maximum":72961.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59247,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59247,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45346.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34010.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34010.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":63780.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47272.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":72961.48,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25186.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25438.76,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25942.5,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25690.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25186.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25186.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25186.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25816.57,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25186.89,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"minimum":16829.81,"maximum":44857.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36425,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36425,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38316.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28738.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28738.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39212.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29063.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44857.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16829.81,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16998.11,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17334.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17166.41,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16829.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16829.81,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16829.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17250.56,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16829.81,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"minimum":12816.38,"maximum":37115.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26586,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26586,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37115.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27837.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27837.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28620.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21212.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32740.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12816.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12944.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13200.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13072.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12816.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12816.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12816.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13136.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12816.38,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES","code_information":[{"code":"5171","type":"APR-DRG"}],"standard_charges":[{"minimum":4480,"maximum":4480,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4480,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4480,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4480,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES","code_information":[{"code":"5172","type":"APR-DRG"}],"standard_charges":[{"minimum":5679,"maximum":5679,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5679,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5679,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5679,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES","code_information":[{"code":"5173","type":"APR-DRG"}],"standard_charges":[{"minimum":9828,"maximum":9828,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9828,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9828,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9828,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES","code_information":[{"code":"5174","type":"APR-DRG"}],"standard_charges":[{"minimum":23894,"maximum":23894,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23894,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23894,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23894,"methodology":"case rate"}]}]},{"description":"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"minimum":25384.33,"maximum":78851.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43879,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43879,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33845.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25384.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25384.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":68928.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":51088.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":78851.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28988.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29278.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29858.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29568.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28988.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28988.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28988.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29713.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28988.44,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"5181","type":"APR-DRG"}],"standard_charges":[{"minimum":5519,"maximum":5519,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5519,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5519,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5519,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"5182","type":"APR-DRG"}],"standard_charges":[{"minimum":7443,"maximum":7443,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7443,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7443,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7443,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"5183","type":"APR-DRG"}],"standard_charges":[{"minimum":14657,"maximum":14657,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14657,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14657,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14657,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"5184","type":"APR-DRG"}],"standard_charges":[{"minimum":20472,"maximum":20472,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20472,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20472,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20472,"methodology":"case rate"}]}]},{"description":"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"minimum":16522.04,"maximum":44153.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43879,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43879,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23420.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17565.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17565.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38597.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28607.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44153.95,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16522.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16687.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17017.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16852.49,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16522.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16522.04,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16522.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16935.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16522.04,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA","code_information":[{"code":"5191","type":"APR-DRG"}],"standard_charges":[{"minimum":5585,"maximum":5585,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5585,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5585,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5585,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA","code_information":[{"code":"5192","type":"APR-DRG"}],"standard_charges":[{"minimum":6952,"maximum":6952,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6952,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6952,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6952,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA","code_information":[{"code":"5193","type":"APR-DRG"}],"standard_charges":[{"minimum":12041,"maximum":12041,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12041,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12041,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12041,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA","code_information":[{"code":"5194","type":"APR-DRG"}],"standard_charges":[{"minimum":23122,"maximum":23122,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23122,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23122,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23122,"methodology":"case rate"}]}]},{"description":"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"minimum":12356.26,"maximum":63651.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24559,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24559,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63651.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47739.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47739.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27057.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20053.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30951.95,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12356.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12479.83,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12726.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12603.39,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12356.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12356.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12356.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12665.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12356.26,"methodology":"case rate"}]}]},{"description":"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"minimum":23812.73,"maximum":63090,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63090,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63090,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51541.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38656.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38656.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23812.73,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24050.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24527.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24288.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23812.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23812.73,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23812.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24408.05,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23812.73,"methodology":"case rate"}]}]},{"description":"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"minimum":17575.28,"maximum":38249,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38249,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38249,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25756.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19317.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19317.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17575.28,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17751.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18102.54,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17926.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17575.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17575.28,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17575.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18014.67,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17575.28,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM MALIGNANCY","code_information":[{"code":"5301","type":"APR-DRG"}],"standard_charges":[{"minimum":3832,"maximum":3832,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3832,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3832,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3832,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM MALIGNANCY","code_information":[{"code":"5302","type":"APR-DRG"}],"standard_charges":[{"minimum":5000,"maximum":5000,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5000,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5000,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5000,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM MALIGNANCY","code_information":[{"code":"5303","type":"APR-DRG"}],"standard_charges":[{"minimum":7520,"maximum":7520,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7520,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7520,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7520,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM MALIGNANCY","code_information":[{"code":"5304","type":"APR-DRG"}],"standard_charges":[{"minimum":13816,"maximum":13816,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13816,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13816,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13816,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM INFECTIONS","code_information":[{"code":"5311","type":"APR-DRG"}],"standard_charges":[{"minimum":3091,"maximum":3091,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3091,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3091,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3091,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM INFECTIONS","code_information":[{"code":"5312","type":"APR-DRG"}],"standard_charges":[{"minimum":4156,"maximum":4156,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM INFECTIONS","code_information":[{"code":"5313","type":"APR-DRG"}],"standard_charges":[{"minimum":6649,"maximum":6649,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6649,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6649,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6649,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM INFECTIONS","code_information":[{"code":"5314","type":"APR-DRG"}],"standard_charges":[{"minimum":12083,"maximum":12083,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12083,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12083,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12083,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS","code_information":[{"code":"5321","type":"APR-DRG"}],"standard_charges":[{"minimum":2965,"maximum":2965,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2965,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2965,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2965,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS","code_information":[{"code":"5322","type":"APR-DRG"}],"standard_charges":[{"minimum":3553,"maximum":3553,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3553,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3553,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3553,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS","code_information":[{"code":"5323","type":"APR-DRG"}],"standard_charges":[{"minimum":5182,"maximum":5182,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5182,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5182,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5182,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS","code_information":[{"code":"5324","type":"APR-DRG"}],"standard_charges":[{"minimum":11293,"maximum":11293,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11293,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11293,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11293,"methodology":"case rate"}]}]},{"description":"FRACTURES OF FEMUR WITH MCC","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"minimum":12340.43,"maximum":30107.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27414,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27414,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16453.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12340.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12340.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26524.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21873.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30107.42,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13065.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13196.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13457.35,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13326.69,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13065.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13065.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13065.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13392.02,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13065.38,"methodology":"case rate"}]}]},{"description":"FRACTURES OF FEMUR WITHOUT MCC","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"minimum":7567.98,"maximum":20492.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14610,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14610,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20492.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15369.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15369.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14136.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11657.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16046.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7567.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7643.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7795.02,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7719.34,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7567.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7567.98,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7567.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7757.18,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7567.98,"methodology":"case rate"}]}]},{"description":"FRACTURES OF HIP AND PELVIS WITH MCC","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"minimum":10409.16,"maximum":25315.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23051,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23051,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13878.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10409.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10409.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22302.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18391.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25315.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11557.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11673.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11904.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11788.59,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11557.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11557.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11557.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11846.38,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11557.44,"methodology":"case rate"}]}]},{"description":"FRACTURES OF HIP AND PELVIS WITHOUT MCC","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":7544,"maximum":15647.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14248,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14248,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12892.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9669.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9669.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13785.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11368.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15647.85,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7544,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7619.44,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7770.32,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7694.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7544,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7544,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7544,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7732.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7544,"methodology":"case rate"}]}]},{"description":"SPRAINS STRAINS AND DISLOCATIONS OF HIP PELVIS AND THIGH WITH CC/MCC","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"minimum":7686.16,"maximum":18791.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17111,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17111,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10248.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7686.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7686.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16555.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13652.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18791.86,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8379.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8463.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8631.34,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8547.54,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8379.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8379.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8379.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8589.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8379.94,"methodology":"case rate"}]}]},{"description":"SPRAINS STRAINS AND DISLOCATIONS OF HIP PELVIS AND THIGH WITHOUT CC/MCC","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"minimum":6466.02,"maximum":27006.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13543,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13543,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27006.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20255.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20255.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13104.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10806.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14874.23,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6466.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6530.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6660.01,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6595.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6466.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6466.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6466.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6627.68,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6466.02,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS WITH MCC","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"minimum":16096.56,"maximum":38891.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35413,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35413,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21461.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16096.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16096.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34263.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28255.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38891.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16912.56,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17081.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17419.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17250.82,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16912.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16912.56,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16912.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17335.38,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16912.56,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION","code_information":[{"code":"5391","type":"APR-DRG"}],"standard_charges":[{"minimum":3397,"maximum":3397,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3397,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3397,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3397,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION","code_information":[{"code":"5392","type":"APR-DRG"}],"standard_charges":[{"minimum":3916,"maximum":3916,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3916,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3916,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3916,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION","code_information":[{"code":"5393","type":"APR-DRG"}],"standard_charges":[{"minimum":6132,"maximum":6132,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6132,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6132,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6132,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION","code_information":[{"code":"5394","type":"APR-DRG"}],"standard_charges":[{"minimum":15432,"maximum":15432,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15432,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15432,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15432,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS WITH CC","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"minimum":11280.6,"maximum":26819,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24420,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24420,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18516.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13887.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13887.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23627.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19484.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26819,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11280.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11393.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11619.02,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11506.22,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11280.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11280.6,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11280.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11562.62,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11280.6,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION","code_information":[{"code":"5401","type":"APR-DRG"}],"standard_charges":[{"minimum":3410,"maximum":3410,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3410,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3410,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3410,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION","code_information":[{"code":"5402","type":"APR-DRG"}],"standard_charges":[{"minimum":4156,"maximum":4156,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION","code_information":[{"code":"5403","type":"APR-DRG"}],"standard_charges":[{"minimum":5645,"maximum":5645,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION","code_information":[{"code":"5404","type":"APR-DRG"}],"standard_charges":[{"minimum":11194,"maximum":11194,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11194,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11194,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11194,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS WITHOUT CC/MCC","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"minimum":8038.92,"maximum":30885.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17032,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17032,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30885.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23164.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23164.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16479.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13589.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18705.22,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8038.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8119.31,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8280.09,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8199.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8038.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8038.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8038.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8239.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8038.92,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C","code_information":[{"code":"5411","type":"APR-DRG"}],"standard_charges":[{"minimum":3067,"maximum":3067,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3067,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3067,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3067,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C","code_information":[{"code":"5412","type":"APR-DRG"}],"standard_charges":[{"minimum":3221,"maximum":3221,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3221,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3221,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3221,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C","code_information":[{"code":"5413","type":"APR-DRG"}],"standard_charges":[{"minimum":4328,"maximum":4328,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4328,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4328,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4328,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C","code_information":[{"code":"5414","type":"APR-DRG"}],"standard_charges":[{"minimum":7015,"maximum":7015,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"}]}]},{"description":"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"minimum":15696.15,"maximum":37645.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34278,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34278,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23150.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17363.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17363.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33165.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27350.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37645.62,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15696.15,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15853.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16167.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16010.08,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15696.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15696.15,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15696.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16088.56,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15696.15,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"5421","type":"APR-DRG"}],"standard_charges":[{"minimum":2257,"maximum":2257,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2257,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2257,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2257,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"5422","type":"APR-DRG"}],"standard_charges":[{"minimum":2719,"maximum":2719,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2719,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2719,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2719,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"5423","type":"APR-DRG"}],"standard_charges":[{"minimum":4292,"maximum":4292,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"5424","type":"APR-DRG"}],"standard_charges":[{"minimum":12330,"maximum":12330,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12330,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12330,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12330,"methodology":"case rate"}]}]},{"description":"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"minimum":9477.26,"maximum":21791.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19842,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19842,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19506.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14629.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14629.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19198.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15831.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21791.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9477.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9572.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9761.58,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9666.81,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9477.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9477.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9477.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9714.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9477.26,"methodology":"case rate"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5431","type":"APR-DRG"}],"standard_charges":[{"minimum":3219,"maximum":3219,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3219,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3219,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3219,"methodology":"case rate"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5432","type":"APR-DRG"}],"standard_charges":[{"minimum":3942,"maximum":3942,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3942,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3942,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3942,"methodology":"case rate"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5433","type":"APR-DRG"}],"standard_charges":[{"minimum":5469,"maximum":5469,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5469,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5469,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5469,"methodology":"case rate"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5434","type":"APR-DRG"}],"standard_charges":[{"minimum":12577,"maximum":12577,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12577,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12577,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12577,"methodology":"case rate"}]}]},{"description":"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"minimum":7117.14,"maximum":39991.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14246,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14246,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39991.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29994.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29994.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13783.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11366.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15645.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7117.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7188.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7330.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7259.49,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7117.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7117.14,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7117.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7295.07,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7117.14,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS WITH MCC","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"minimum":19787.78,"maximum":52152.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47488,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47488,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26383.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19787.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19787.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45946.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37889.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52152.64,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20813.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21022.01,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21438.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21230.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20813.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20813.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20813.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21334.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20813.87,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS WITH CC","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"minimum":10225.82,"maximum":24826.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22605,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22605,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19755.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14816.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14816.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21871.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18036.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24826.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10225.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10328.08,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10532.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10430.34,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10225.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10225.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10225.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10481.47,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10225.82,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"minimum":7043.68,"maximum":28272.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15217,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15217,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28272.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21205.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21205.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14723.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12141.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16712.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7043.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7114.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7255,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7184.56,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7043.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7043.68,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7043.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7219.78,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7043.68,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITH O.R. PROCEDURE","code_information":[{"code":"5471","type":"APR-DRG"}],"standard_charges":[{"minimum":3771,"maximum":3771,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3771,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3771,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3771,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITH O.R. PROCEDURE","code_information":[{"code":"5472","type":"APR-DRG"}],"standard_charges":[{"minimum":5407,"maximum":5407,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5407,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5407,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5407,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITH O.R. PROCEDURE","code_information":[{"code":"5473","type":"APR-DRG"}],"standard_charges":[{"minimum":8683,"maximum":8683,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8683,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8683,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8683,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITH O.R. PROCEDURE","code_information":[{"code":"5474","type":"APR-DRG"}],"standard_charges":[{"minimum":16217,"maximum":16217,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16217,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16217,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16217,"methodology":"case rate"}]}]},{"description":"SEPTIC ARTHRITIS WITH MCC","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"minimum":15894.08,"maximum":40915.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37256,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37256,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21191.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15894.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15894.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":36046.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29725.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40915.47,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16852.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17020.77,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17357.81,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17189.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16852.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16852.24,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16852.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17273.55,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16852.24,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"5481","type":"APR-DRG"}],"standard_charges":[{"minimum":2327,"maximum":2327,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"5482","type":"APR-DRG"}],"standard_charges":[{"minimum":5050,"maximum":5050,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5050,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5050,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5050,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"5483","type":"APR-DRG"}],"standard_charges":[{"minimum":9870,"maximum":9870,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9870,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9870,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9870,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"5484","type":"APR-DRG"}],"standard_charges":[{"minimum":30827,"maximum":30827,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30827,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30827,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30827,"methodology":"case rate"}]}]},{"description":"SEPTIC ARTHRITIS WITH CC","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"minimum":10592.36,"maximum":24613.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22412,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22412,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17595.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13197.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13197.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21684.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17882.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24613.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10592.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10698.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10910.14,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10804.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10592.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10592.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10592.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10857.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10592.36,"methodology":"case rate"}]}]},{"description":"SEPTIC ARTHRITIS WITHOUT CC/MCC","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"minimum":7939.94,"maximum":29186.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16230,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16230,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29186.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21890.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21890.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15703.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12949.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17824.32,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7939.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8019.34,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8178.14,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8098.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7939.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7939.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7939.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8138.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7939.94,"methodology":"case rate"}]}]},{"description":"MEDICAL BACK PROBLEMS WITH MCC","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"minimum":13812.25,"maximum":36767.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29856,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29856,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18415.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13812.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13812.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32140.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23821.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36767.59,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14468.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14613.61,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14902.99,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14758.3,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14468.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14468.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14468.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14830.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14468.92,"methodology":"case rate"}]}]},{"description":"MEDICAL BACK PROBLEMS WITHOUT MCC","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":8726.38,"maximum":21094.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17130,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17130,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20624.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15468.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15468.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18440.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13667.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21094.98,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8726.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8813.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8988.18,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8900.91,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8726.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8726.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8726.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8944.54,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8726.38,"methodology":"case rate"}]}]},{"description":"BONE DISEASES AND ARTHROPATHIES WITH MCC","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"minimum":10886.79,"maximum":29737.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24148,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24148,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14515.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10886.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10886.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25995.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19267.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29737.47,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11372.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11486.35,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11713.8,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11600.08,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11372.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11372.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11372.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11656.94,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11372.62,"methodology":"case rate"}]}]},{"description":"BONE DISEASES AND ARTHROPATHIES WITHOUT MCC","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"minimum":7727.28,"maximum":18210.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14787,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14787,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16166.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12124.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12124.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15918.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11798.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18210.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7727.28,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7804.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7959.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7881.83,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7727.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7727.28,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7727.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7920.47,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7727.28,"methodology":"case rate"}]}]},{"description":"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"minimum":9160.58,"maximum":30426.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24707,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24707,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12213.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9160.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9160.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26597.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19713.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30426.83,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11686.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11803.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12037.18,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11920.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11686.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11686.58,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11686.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11978.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11686.58,"methodology":"case rate"}]}]},{"description":"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"minimum":7587.31,"maximum":20703.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14873,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14873,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20703.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15528.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15528.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16011.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11867.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18316.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7663.19,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7814.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7739.06,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7777,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"}]}]},{"description":"TENDONITIS MYOSITIS AND BURSITIS WITH MCC","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"minimum":10816.7,"maximum":30082.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27392,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27392,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14421.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10816.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10816.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26502.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21855.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30082.66,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13257.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13389.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13654.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13522.31,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13257.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13257.16,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13257.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13588.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13257.16,"methodology":"case rate"}]}]},{"description":"TENDONITIS MYOSITIS AND BURSITIS WITHOUT MCC","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":7953.08,"maximum":32277.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16181,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16181,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32277.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24208.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24208.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15655.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12910.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17770.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7953.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8032.62,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8191.68,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8112.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7953.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7953.08,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7953.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8151.91,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7953.08,"methodology":"case rate"}]}]},{"description":"AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"minimum":13931.66,"maximum":37171.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33846,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33846,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18575.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13931.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13931.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32747.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27005.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37171.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15628.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15784.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16096.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15940.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15628.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15628.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15628.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16018.81,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15628.1,"methodology":"case rate"}]}]},{"description":"AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"minimum":10078.89,"maximum":21527.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19602,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19602,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13643.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10232.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10232.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18965.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15639.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21527.4,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10078.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10179.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10381.26,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10280.47,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10078.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10078.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10078.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10330.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10078.89,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY","code_information":[{"code":"5601","type":"APR-DRG"}],"standard_charges":[{"minimum":1992,"maximum":1992,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1992,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1992,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1992,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY","code_information":[{"code":"5602","type":"APR-DRG"}],"standard_charges":[{"minimum":2246,"maximum":2246,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2246,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2246,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2246,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY","code_information":[{"code":"5603","type":"APR-DRG"}],"standard_charges":[{"minimum":3143,"maximum":3143,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3143,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3143,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3143,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY","code_information":[{"code":"5604","type":"APR-DRG"}],"standard_charges":[{"minimum":4720,"maximum":4720,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4720,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4720,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4720,"methodology":"case rate"}]}]},{"description":"AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"minimum":7595.82,"maximum":23119.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14039,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14039,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23119.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17339.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17339.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13583.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11202.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15418.86,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7595.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7671.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7823.7,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7747.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7595.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7595.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7595.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7785.72,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7595.82,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE","code_information":[{"code":"5611","type":"APR-DRG"}],"standard_charges":[{"minimum":1754,"maximum":1754,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1754,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1754,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1754,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE","code_information":[{"code":"5612","type":"APR-DRG"}],"standard_charges":[{"minimum":2629,"maximum":2629,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2629,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2629,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2629,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE","code_information":[{"code":"5613","type":"APR-DRG"}],"standard_charges":[{"minimum":4242,"maximum":4242,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4242,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4242,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE","code_information":[{"code":"5614","type":"APR-DRG"}],"standard_charges":[{"minimum":8960,"maximum":8960,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8960,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8960,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8960,"methodology":"case rate"}]}]},{"description":"FRACTURE SPRAIN STRAIN AND DISLOCATION EXCEPT FEMUR HIP PELVIS AND THIGH WITH MCC","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"minimum":10842.66,"maximum":27790.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25305,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25305,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14456.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10842.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10842.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24483.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20190.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27790.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12590.57,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12716.48,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12968.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12842.39,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12590.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12590.57,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12590.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12905.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12590.57,"methodology":"case rate"}]}]},{"description":"FRACTURE SPRAIN STRAIN AND DISLOCATION EXCEPT FEMUR HIP PELVIS AND THIGH WITHOUT MCC","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"minimum":8185.07,"maximum":21233.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16042,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16042,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21233.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15925.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15925.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15521.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12799.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17618.02,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8185.07,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8266.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8430.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8348.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8185.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8185.07,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8185.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8389.7,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8185.07,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"minimum":12353.41,"maximum":31192.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28402,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28402,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16470.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12353.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12353.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27480.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22661.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31192.56,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13407.95,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13542.03,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13810.19,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13676.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13407.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13407.95,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13407.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13743.15,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13407.95,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5641","type":"APR-DRG"}],"standard_charges":[{"minimum":1926,"maximum":1926,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1926,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1926,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5642","type":"APR-DRG"}],"standard_charges":[{"minimum":2555,"maximum":2555,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2555,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2555,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2555,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5643","type":"APR-DRG"}],"standard_charges":[{"minimum":3997,"maximum":3997,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3997,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3997,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3997,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5644","type":"APR-DRG"}],"standard_charges":[{"minimum":9549,"maximum":9549,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9549,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9549,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9549,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"minimum":9158.66,"maximum":20227.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18418,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18418,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14252.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10689.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10689.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17820.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14695.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20227.71,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9158.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9250.25,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9433.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9341.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9158.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9158.66,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9158.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9387.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9158.66,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"minimum":7058.37,"maximum":48156.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14233,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14233,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48156.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36117.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36117.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13771.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11356.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15631.35,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7058.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7128.96,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7270.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7199.54,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7058.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7058.37,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7058.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7234.83,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7058.37,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITHOUT O.R. PROCEDURE","code_information":[{"code":"5661","type":"APR-DRG"}],"standard_charges":[{"minimum":1801,"maximum":1801,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1801,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1801,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1801,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITHOUT O.R. PROCEDURE","code_information":[{"code":"5662","type":"APR-DRG"}],"standard_charges":[{"minimum":2358,"maximum":2358,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2358,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2358,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2358,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITHOUT O.R. PROCEDURE","code_information":[{"code":"5663","type":"APR-DRG"}],"standard_charges":[{"minimum":3496,"maximum":3496,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3496,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3496,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3496,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITHOUT O.R. PROCEDURE","code_information":[{"code":"5664","type":"APR-DRG"}],"standard_charges":[{"minimum":7618,"maximum":7618,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7618,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7618,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7618,"methodology":"case rate"}]}]},{"description":"SKIN DEBRIDEMENT WITH MCC","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"minimum":22149.96,"maximum":59274.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53973,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53973,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29532.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22149.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22149.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":52220.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":43063.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":59274.11,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24551.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24796.75,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25287.77,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25042.26,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24551.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24551.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24551.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25165.02,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24551.23,"methodology":"case rate"}]}]},{"description":"SKIN DEBRIDEMENT WITH CC","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"minimum":14173.07,"maximum":34499.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31414,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31414,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18897.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14173.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14173.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30394.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25064.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34499.54,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14220.69,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14362.9,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14647.32,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14505.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14220.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14220.69,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14220.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14576.21,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14220.69,"methodology":"case rate"}]}]},{"description":"SKIN DEBRIDEMENT WITHOUT CC/MCC","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"minimum":10107.5,"maximum":63651.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21071,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21071,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63651.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47739.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47739.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20386.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16812.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23140.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10107.5,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10208.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10410.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10309.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10107.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10107.5,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10107.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10360.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10107.5,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"minimum":37613.14,"maximum":109654.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99847,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99847,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50149.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37613.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37613.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":96605.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":79665.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":109654.63,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":48894.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49383.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50361.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":49872.68,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":48894.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":48894.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":48894.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50117.15,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":48894.78,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"minimum":17103.73,"maximum":64402.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58643,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58643,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22804.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17103.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17103.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":56738.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":46789.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64402.73,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28067.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28348.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28909.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28628.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28067.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28067.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28067.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28769.13,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28067.44,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"minimum":16713.82,"maximum":64928.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33005,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33005,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64928.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48697.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48697.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31933.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26333.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36246.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16713.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16880.96,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17215.24,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17048.1,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16713.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16713.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16713.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17131.67,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16713.82,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"minimum":25254.54,"maximum":100038.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91092,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91092,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33672.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25254.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25254.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":88134.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":72679.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":100038.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42995.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43425.22,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44285.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43855.17,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42995.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42995.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42995.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":44070.15,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42995.26,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"minimum":14892.1,"maximum":49833.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45377,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45377,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19855.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14892.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14892.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":43903.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36205.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49833.82,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21864.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22083.43,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22520.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22302.08,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21864.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21864.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21864.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22411.4,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21864.78,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"minimum":14345.2,"maximum":48813.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30570,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30570,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48813.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36611.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36611.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29577.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24391.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33573.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14345.2,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14488.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14775.56,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14632.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14345.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14345.2,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14345.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14703.83,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14345.2,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"minimum":23294.71,"maximum":61603.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56093,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56093,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31059.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23294.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23294.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":54272.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":44755.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61603.24,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26478.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26743.09,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27272.65,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27007.87,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26478.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26478.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26478.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27140.26,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26478.3,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"minimum":14983.94,"maximum":33187.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30219,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30219,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21060.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15795.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15795.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29238.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24111.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33187.48,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14983.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15133.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15433.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15283.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14983.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14983.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14983.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15358.54,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14983.94,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD NOT BORN HERE","code_information":[{"code":"5801","type":"APR-DRG"}],"standard_charges":[{"minimum":1524,"maximum":1524,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD NOT BORN HERE","code_information":[{"code":"5802","type":"APR-DRG"}],"standard_charges":[{"minimum":2210,"maximum":2210,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2210,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2210,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2210,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD NOT BORN HERE","code_information":[{"code":"5803","type":"APR-DRG"}],"standard_charges":[{"minimum":3747,"maximum":3747,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3747,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3747,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3747,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD NOT BORN HERE","code_information":[{"code":"5804","type":"APR-DRG"}],"standard_charges":[{"minimum":6659,"maximum":6659,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6659,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6659,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6659,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"minimum":12402.66,"maximum":31218.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23571,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23571,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31218.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23414.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23414.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22805.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18806.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25886.52,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12402.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12526.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12774.74,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12650.72,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12402.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12402.66,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12402.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12712.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12402.66,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD BORN HERE","code_information":[{"code":"5811","type":"APR-DRG"}],"standard_charges":[{"minimum":644,"maximum":644,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":644,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":644,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":644,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD BORN HERE","code_information":[{"code":"5812","type":"APR-DRG"}],"standard_charges":[{"minimum":980,"maximum":980,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":980,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":980,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":980,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD BORN HERE","code_information":[{"code":"5813","type":"APR-DRG"}],"standard_charges":[{"minimum":1691,"maximum":1691,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1691,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1691,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1691,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD BORN HERE","code_information":[{"code":"5814","type":"APR-DRG"}],"standard_charges":[{"minimum":3123,"maximum":3123,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3123,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3123,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3123,"methodology":"case rate"}]}]},{"description":"MASTECTOMY FOR MALIGNANCY WITH CC/MCC","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"minimum":14815.36,"maximum":32568.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29655,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29655,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26448.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19837.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19837.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28692.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23661.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32568.58,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14815.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14963.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15259.83,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15111.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14815.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14815.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14815.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15185.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14815.36,"methodology":"case rate"}]}]},{"description":"MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"minimum":13976.33,"maximum":40656.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27452,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27452,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40656.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30492.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30492.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26560.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21903.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30148.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13976.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14116.1,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14395.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14255.86,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13976.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13976.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13976.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14325.74,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13976.33,"methodology":"case rate"}]}]},{"description":"NEONATE WITH ECMO","code_information":[{"code":"5831","type":"APR-DRG"}],"standard_charges":[{"minimum":106919,"maximum":106919,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106919,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106919,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106919,"methodology":"case rate"}]}]},{"description":"NEONATE WITH ECMO","code_information":[{"code":"5832","type":"APR-DRG"}],"standard_charges":[{"minimum":135320,"maximum":135320,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":135320,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":135320,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":135320,"methodology":"case rate"}]}]},{"description":"NEONATE WITH ECMO","code_information":[{"code":"5833","type":"APR-DRG"}],"standard_charges":[{"minimum":199435,"maximum":199435,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":199435,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":199435,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":199435,"methodology":"case rate"}]}]},{"description":"NEONATE WITH ECMO","code_information":[{"code":"5834","type":"APR-DRG"}],"standard_charges":[{"minimum":248255,"maximum":248255,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":248255,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":248255,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":248255,"methodology":"case rate"}]}]},{"description":"BREAST BIOPSY LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"minimum":17105.88,"maximum":37719.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34346,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34346,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37067.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27801.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27801.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33231.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27404.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37719.89,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17105.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17276.94,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17619.06,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17448,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17105.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17105.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17105.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17533.53,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17105.88,"methodology":"case rate"}]}]},{"description":"BREAST BIOPSY LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"minimum":16624.12,"maximum":35015.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31883,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31883,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23673.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17755.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17755.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30848.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25439.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35015.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16624.12,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16790.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17122.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16956.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16624.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16624.12,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16624.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17039.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16624.12,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"5881","type":"APR-DRG"}],"standard_charges":[{"minimum":57869,"maximum":57869,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57869,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57869,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57869,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"5882","type":"APR-DRG"}],"standard_charges":[{"minimum":57869,"maximum":57869,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57869,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57869,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57869,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"5883","type":"APR-DRG"}],"standard_charges":[{"minimum":119869,"maximum":119869,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119869,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119869,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119869,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"5884","type":"APR-DRG"}],"standard_charges":[{"minimum":196648,"maximum":196648,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":196648,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":196648,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":196648,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 500 GRAMS OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION","code_information":[{"code":"5891","type":"APR-DRG"}],"standard_charges":[{"minimum":82923,"maximum":82923,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":82923,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":82923,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":82923,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 500 GRAMS OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION","code_information":[{"code":"5892","type":"APR-DRG"}],"standard_charges":[{"minimum":79989,"maximum":79989,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79989,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79989,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79989,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 500 GRAMS OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION","code_information":[{"code":"5893","type":"APR-DRG"}],"standard_charges":[{"minimum":72717,"maximum":72717,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72717,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72717,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72717,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 500 GRAMS OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION","code_information":[{"code":"5894","type":"APR-DRG"}],"standard_charges":[{"minimum":13778,"maximum":13778,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13778,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13778,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13778,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5911","type":"APR-DRG"}],"standard_charges":[{"minimum":52045,"maximum":52045,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52045,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52045,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5912","type":"APR-DRG"}],"standard_charges":[{"minimum":72184,"maximum":72184,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72184,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72184,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72184,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5913","type":"APR-DRG"}],"standard_charges":[{"minimum":79792,"maximum":79792,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79792,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79792,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79792,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5914","type":"APR-DRG"}],"standard_charges":[{"minimum":134261,"maximum":134261,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134261,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134261,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134261,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS WITH MCC","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"minimum":13492.97,"maximum":36810.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33518,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33518,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17990.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13492.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13492.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32429.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26743.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36810.1,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17174.71,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17346.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17689.96,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17518.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17174.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17174.71,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17174.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17604.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17174.71,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS WITH CC","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"minimum":10728.46,"maximum":23679.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21561,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21561,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15183.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11387.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11387.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20861.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17203.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23679.11,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10728.46,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10835.75,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11050.32,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10943.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10728.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10728.46,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10728.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10996.68,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10728.46,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5931","type":"APR-DRG"}],"standard_charges":[{"minimum":17460,"maximum":17460,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17460,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17460,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17460,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5932","type":"APR-DRG"}],"standard_charges":[{"minimum":66867,"maximum":66867,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66867,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66867,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66867,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5933","type":"APR-DRG"}],"standard_charges":[{"minimum":77192,"maximum":77192,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":77192,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":77192,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77192,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5934","type":"APR-DRG"}],"standard_charges":[{"minimum":111465,"maximum":111465,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111465,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111465,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111465,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS WITHOUT CC/MCC","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"minimum":7836.31,"maximum":28041.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15210,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15210,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28041.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21031.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21031.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14716.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12135.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16704.11,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7836.31,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7914.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8071.4,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7993.04,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7836.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7836.31,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7836.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8032.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7836.31,"methodology":"case rate"}]}]},{"description":"MAJOR SKIN DISORDERS WITH MCC","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"minimum":13171.09,"maximum":41932.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38182,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38182,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17561.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13171.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13171.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":36942.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30464.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41932.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17629.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17805.71,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18158.3,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17982,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17629.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17629.41,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17629.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18070.15,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17629.41,"methodology":"case rate"}]}]},{"description":"MAJOR SKIN DISORDERS WITHOUT MCC","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"minimum":9633.47,"maximum":29698.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18298,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18298,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29698.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22274.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22274.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17704.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14599.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20095.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9633.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9729.81,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9922.48,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9826.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9633.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9633.47,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9633.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9874.31,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9633.47,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS WITH MCC","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"minimum":14857.89,"maximum":34924.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31801,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31801,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22631.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16973.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16973.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30768.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25373.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34924.52,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15006.47,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15303.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15155.05,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15229.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14857.89,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS WITH CC","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"minimum":9616.45,"maximum":22457.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20449,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20449,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15304.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11478.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11478.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19785.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16315.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22457.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9616.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9712.62,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9904.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9808.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9616.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9616.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9616.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9856.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9616.45,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS WITHOUT CC/MCC","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"minimum":7884.26,"maximum":16955.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13063,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13063,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16955.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12716.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12716.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12638.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10422.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14346.1,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7884.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7963.11,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8120.79,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8041.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7884.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7884.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7884.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8081.37,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7884.26,"methodology":"case rate"}]}]},{"description":"HOME HEALTH OXYGEN - GENERAL","code_information":[{"code":"600","type":"RC"}],"standard_charges":[{"minimum":9.19,"maximum":12.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NON-MALIGNANT BREAST DISORDERS WITH CC/MCC","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"minimum":8670.71,"maximum":19788.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18018,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18018,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13439.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10079.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10079.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17433.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14376.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19788.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8670.71,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8757.42,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8930.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8844.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8670.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8670.71,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8670.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8887.48,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8670.71,"methodology":"case rate"}]}]},{"description":"NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"minimum":5909.24,"maximum":21274.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11624,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11624,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21274.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15956.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15956.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11246.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9274.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12765.84,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5909.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5968.34,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6086.52,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6027.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5909.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5909.24,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5909.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6056.98,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5909.24,"methodology":"case rate"}]}]},{"description":"CELLULITIS WITH MCC","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":11198.28,"maximum":29496.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26858,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26858,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14930.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11198.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11198.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25986.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21429.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29496.77,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12634.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12761,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13013.69,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12887.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12634.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12634.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12634.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12950.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12634.65,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6021","type":"APR-DRG"}],"standard_charges":[{"minimum":18360,"maximum":18360,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18360,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18360,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18360,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6022","type":"APR-DRG"}],"standard_charges":[{"minimum":52706,"maximum":52706,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52706,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52706,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52706,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6023","type":"APR-DRG"}],"standard_charges":[{"minimum":58807,"maximum":58807,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58807,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58807,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58807,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6024","type":"APR-DRG"}],"standard_charges":[{"minimum":86257,"maximum":86257,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86257,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86257,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86257,"methodology":"case rate"}]}]},{"description":"CELLULITIS WITHOUT MCC","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":8084.54,"maximum":22589.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15845,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15845,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22589.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16942.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16942.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15330.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12642.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17401.4,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8084.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8165.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8327.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8246.24,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8084.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8084.54,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8084.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8286.66,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8084.54,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6031","type":"APR-DRG"}],"standard_charges":[{"minimum":17305,"maximum":17305,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17305,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17305,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6032","type":"APR-DRG"}],"standard_charges":[{"minimum":32831,"maximum":32831,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32831,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32831,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32831,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6033","type":"APR-DRG"}],"standard_charges":[{"minimum":50341,"maximum":50341,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50341,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50341,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50341,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6034","type":"APR-DRG"}],"standard_charges":[{"minimum":104420,"maximum":104420,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104420,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104420,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104420,"methodology":"case rate"}]}]},{"description":"TRAUMA TO THE SKIN SUBCUTANEOUS TISSUE AND BREAST WITH MCC","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"minimum":12010.77,"maximum":30212.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27510,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27510,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16014.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12010.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12010.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26617.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21949.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30212.63,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12762.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12889.88,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13145.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13017.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12762.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12762.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12762.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13081.31,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12762.25,"methodology":"case rate"}]}]},{"description":"TRAUMA TO THE SKIN SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"minimum":8416.29,"maximum":18065.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16450,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16450,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17384.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13038.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13038.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15915.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13124.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18065.69,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8416.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8500.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8668.78,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8584.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8416.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8416.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8416.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8626.7,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8416.29,"methodology":"case rate"}]}]},{"description":"MINOR SKIN DISORDERS WITH MCC","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"minimum":9196.92,"maximum":30852.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28092,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28092,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12262.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9196.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9196.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27180.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22414.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30852.16,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13725.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13863.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14137.56,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14000.3,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13725.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13725.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13725.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14068.93,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13725.78,"methodology":"case rate"}]}]},{"description":"MINOR SKIN DISORDERS WITHOUT MCC","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"minimum":7956.17,"maximum":63599.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15518,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15518,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63599.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47700.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47700.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15014.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12381.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17042.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7956.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8035.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8194.86,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8115.3,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7956.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7956.17,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7956.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8155.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7956.17,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6071","type":"APR-DRG"}],"standard_charges":[{"minimum":21106,"maximum":21106,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21106,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21106,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21106,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6072","type":"APR-DRG"}],"standard_charges":[{"minimum":37016,"maximum":37016,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37016,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37016,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37016,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6073","type":"APR-DRG"}],"standard_charges":[{"minimum":46129,"maximum":46129,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46129,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46129,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46129,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6074","type":"APR-DRG"}],"standard_charges":[{"minimum":71909,"maximum":71909,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71909,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71909,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71909,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6081","type":"APR-DRG"}],"standard_charges":[{"minimum":9862,"maximum":9862,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9862,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9862,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9862,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6082","type":"APR-DRG"}],"standard_charges":[{"minimum":26805,"maximum":26805,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26805,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26805,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26805,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6083","type":"APR-DRG"}],"standard_charges":[{"minimum":39229,"maximum":39229,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39229,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39229,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39229,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6084","type":"APR-DRG"}],"standard_charges":[{"minimum":63699,"maximum":63699,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63699,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63699,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63699,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"6091","type":"APR-DRG"}],"standard_charges":[{"minimum":35656,"maximum":35656,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35656,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35656,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35656,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"6092","type":"APR-DRG"}],"standard_charges":[{"minimum":35656,"maximum":35656,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35656,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35656,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35656,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"6093","type":"APR-DRG"}],"standard_charges":[{"minimum":52597,"maximum":52597,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52597,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52597,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52597,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"6094","type":"APR-DRG"}],"standard_charges":[{"minimum":131522,"maximum":131522,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":131522,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":131522,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":131522,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6111","type":"APR-DRG"}],"standard_charges":[{"minimum":12040,"maximum":12040,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12040,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12040,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12040,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6112","type":"APR-DRG"}],"standard_charges":[{"minimum":19529,"maximum":19529,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19529,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19529,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19529,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6113","type":"APR-DRG"}],"standard_charges":[{"minimum":33415,"maximum":33415,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33415,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33415,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33415,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6114","type":"APR-DRG"}],"standard_charges":[{"minimum":57957,"maximum":57957,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57957,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57957,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57957,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6121","type":"APR-DRG"}],"standard_charges":[{"minimum":15028,"maximum":15028,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15028,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15028,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15028,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6122","type":"APR-DRG"}],"standard_charges":[{"minimum":22904,"maximum":22904,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22904,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22904,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22904,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6123","type":"APR-DRG"}],"standard_charges":[{"minimum":31446,"maximum":31446,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31446,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31446,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31446,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6124","type":"APR-DRG"}],"standard_charges":[{"minimum":47573,"maximum":47573,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47573,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47573,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47573,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6131","type":"APR-DRG"}],"standard_charges":[{"minimum":12956,"maximum":12956,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12956,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12956,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12956,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6132","type":"APR-DRG"}],"standard_charges":[{"minimum":21667,"maximum":21667,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21667,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21667,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21667,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6133","type":"APR-DRG"}],"standard_charges":[{"minimum":29882,"maximum":29882,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29882,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29882,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29882,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6134","type":"APR-DRG"}],"standard_charges":[{"minimum":47811,"maximum":47811,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47811,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47811,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47811,"methodology":"case rate"}]}]},{"description":"ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"minimum":18896.85,"maximum":56289.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45709,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45709,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47249.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35437.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35437.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":49206.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36470.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":56289.52,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18896.85,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19085.82,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19463.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19274.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18896.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18896.85,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18896.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19369.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18896.85,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6141","type":"APR-DRG"}],"standard_charges":[{"minimum":8091,"maximum":8091,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8091,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8091,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8091,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6142","type":"APR-DRG"}],"standard_charges":[{"minimum":15750,"maximum":15750,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15750,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15750,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15750,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6143","type":"APR-DRG"}],"standard_charges":[{"minimum":26892,"maximum":26892,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26892,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26892,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26892,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6144","type":"APR-DRG"}],"standard_charges":[{"minimum":37280,"maximum":37280,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37280,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37280,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37280,"methodology":"case rate"}]}]},{"description":"ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"minimum":12354.72,"maximum":61675.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27878,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27878,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61675.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46257.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46257.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30011.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22243.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34331.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12354.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12478.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12725.37,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12601.82,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12354.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12354.72,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12354.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12663.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12354.72,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITH MCC","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"minimum":31161.42,"maximum":82536.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75155,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75155,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43283.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32463.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32463.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":72714.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":59963.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82536.5,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31161.42,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31473.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32096.27,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31784.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31161.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31161.42,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31161.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31940.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31161.42,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITH CC","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"minimum":16210.4,"maximum":42318.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38533,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38533,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34426.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25820.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25820.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37282.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30744.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42318.31,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16210.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16372.51,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16696.72,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16534.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16210.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16210.4,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16210.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16615.66,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16210.4,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"minimum":10901.68,"maximum":62370.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23565,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23565,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62370.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46778.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46778.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22800.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18802.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25880.33,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10901.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11010.7,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11228.74,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11119.72,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10901.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10901.68,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10901.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11174.23,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10901.68,"methodology":"case rate"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITH MCC","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"minimum":22357.38,"maximum":63509.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57829,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57829,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43560.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32670.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32670.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":55951.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":46140.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":63509.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22357.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22580.96,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23028.11,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22804.53,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22357.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22357.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22357.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22916.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22357.38,"methodology":"case rate"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITH CC","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"minimum":13622.93,"maximum":38102.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33711,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33711,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38102.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28577.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28577.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32616.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26897.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37022.59,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13622.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13759.16,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14031.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13895.39,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13622.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13622.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13622.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13963.51,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13622.93,"methodology":"case rate"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"minimum":12577.43,"maximum":55777.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29530,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29530,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55777.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41833.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41833.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28571.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23561.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32430.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12577.43,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12703.21,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12954.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12828.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12577.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12577.43,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12577.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12891.87,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12577.43,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6211","type":"APR-DRG"}],"standard_charges":[{"minimum":4838,"maximum":4838,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4838,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4838,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4838,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6212","type":"APR-DRG"}],"standard_charges":[{"minimum":13924,"maximum":13924,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13924,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13924,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13924,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6213","type":"APR-DRG"}],"standard_charges":[{"minimum":25876,"maximum":25876,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25876,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25876,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25876,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6214","type":"APR-DRG"}],"standard_charges":[{"minimum":44957,"maximum":44957,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44957,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44957,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44957,"methodology":"case rate"}]}]},{"description":"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITH MCC","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"minimum":30210.26,"maximum":77888.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70922,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70922,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41061.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30796.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30796.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":68619.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":56587.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":77888.56,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":30210.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":30512.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31116.57,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30814.47,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":30210.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30210.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":30210.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30965.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":30210.26,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6221","type":"APR-DRG"}],"standard_charges":[{"minimum":9723,"maximum":9723,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9723,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9723,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6222","type":"APR-DRG"}],"standard_charges":[{"minimum":14171,"maximum":14171,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14171,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14171,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14171,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6223","type":"APR-DRG"}],"standard_charges":[{"minimum":19401,"maximum":19401,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19401,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19401,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19401,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6224","type":"APR-DRG"}],"standard_charges":[{"minimum":34714,"maximum":34714,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34714,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34714,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34714,"methodology":"case rate"}]}]},{"description":"MEDICAL/SURGICAL SUPPLIES - SURGICAL DRESSINGS","code_information":[{"code":"623","type":"RC"}],"standard_charges":[{"minimum":0.83,"maximum":1.1,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITH CC","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"minimum":16065.02,"maximum":40282.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36679,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36679,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32855.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24641.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24641.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35488.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29265.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40282.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16065.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16225.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16546.98,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16386.33,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16065.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16065.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16065.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16466.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16065.02,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6231","type":"APR-DRG"}],"standard_charges":[{"minimum":7420,"maximum":7420,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7420,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7420,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7420,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6232","type":"APR-DRG"}],"standard_charges":[{"minimum":13029,"maximum":13029,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13029,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13029,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13029,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6233","type":"APR-DRG"}],"standard_charges":[{"minimum":24651,"maximum":24651,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24651,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24651,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24651,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6234","type":"APR-DRG"}],"standard_charges":[{"minimum":40450,"maximum":40450,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40450,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40450,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40450,"methodology":"case rate"}]}]},{"description":"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"minimum":9030.29,"maximum":37711.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20701,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20701,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37711.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28283.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28283.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20028.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16516.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22734.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9030.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9120.6,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9301.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9210.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9030.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9030.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9030.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9256.05,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9030.29,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"minimum":18082.34,"maximum":60344.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54948,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54948,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24109.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18082.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18082.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":53163.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":43841.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":60344.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23444.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23679.09,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24147.98,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23913.54,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23444.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23444.64,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23444.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24030.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23444.64,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6251","type":"APR-DRG"}],"standard_charges":[{"minimum":8418,"maximum":8418,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8418,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8418,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8418,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6252","type":"APR-DRG"}],"standard_charges":[{"minimum":12999,"maximum":12999,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12999,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12999,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12999,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6253","type":"APR-DRG"}],"standard_charges":[{"minimum":21760,"maximum":21760,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21760,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21760,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21760,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6254","type":"APR-DRG"}],"standard_charges":[{"minimum":49090,"maximum":49090,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49090,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49090,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49090,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"minimum":12944.75,"maximum":34716.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31611,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31611,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19340.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14505.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14505.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30584.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25221.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34716.16,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12944.75,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13074.2,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13333.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13203.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12944.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12944.75,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12944.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13268.37,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12944.75,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6261","type":"APR-DRG"}],"standard_charges":[{"minimum":1166,"maximum":1166,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6262","type":"APR-DRG"}],"standard_charges":[{"minimum":1675,"maximum":1675,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1675,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1675,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1675,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6263","type":"APR-DRG"}],"standard_charges":[{"minimum":4400,"maximum":4400,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4400,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4400,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4400,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6264","type":"APR-DRG"}],"standard_charges":[{"minimum":16060,"maximum":16060,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16060,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16060,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16060,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"minimum":11070.26,"maximum":51195.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21446,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21446,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51195.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38397.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38397.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20750.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17111.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23553.27,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11070.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11180.97,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11402.37,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11291.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11070.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11070.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11070.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11347.02,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11070.26,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"minimum":31027.6,"maximum":76110.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69303,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69303,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41369.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31027.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31027.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":67053.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":55295.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":76110.25,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31785.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32103.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32739.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32421.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31785.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31785.47,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31785.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32580.11,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31785.47,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"minimum":18665.63,"maximum":47919.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43633,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43633,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29723.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22292.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22292.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":42216.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34814.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47919.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18665.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18852.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19225.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19038.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18665.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18665.63,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18665.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19132.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18665.63,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"minimum":12109.58,"maximum":29888.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27215,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27215,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21890.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16418.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16418.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26331.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21714.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29888.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12109.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12230.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12472.87,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12351.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12109.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12109.58,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12109.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12412.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12109.58,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE","code_information":[{"code":"6301","type":"APR-DRG"}],"standard_charges":[{"minimum":19395,"maximum":19395,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19395,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19395,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19395,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE","code_information":[{"code":"6302","type":"APR-DRG"}],"standard_charges":[{"minimum":31385,"maximum":31385,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31385,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31385,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31385,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE","code_information":[{"code":"6303","type":"APR-DRG"}],"standard_charges":[{"minimum":56387,"maximum":56387,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56387,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56387,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56387,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE","code_information":[{"code":"6304","type":"APR-DRG"}],"standard_charges":[{"minimum":112934,"maximum":112934,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112934,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112934,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112934,"methodology":"case rate"}]}]},{"description":"RACEPINEPHRINE 2.25% 0.5ML NEB","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"6306278","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-5901-99","type":"NDC"}],"standard_charges":[{"minimum":2.12,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"RACEPINEPHRINE 2.25% 0.5ML NEB","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"6306278","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-5901-99","type":"NDC"}],"standard_charges":[{"minimum":0.56,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL 0.083% 3ML INH SOL","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6306328","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-9501-01","type":"NDC"}],"standard_charges":[{"minimum":3.71,"maximum":5.72,"gross_charge":7,"discounted_cash":1.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL 0.083% 3ML INH SOL","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6306328","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-9501-01","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":5.72,"gross_charge":7,"discounted_cash":1.61,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"}]}]},{"description":"IPRATROP 0.02% 2.5ML NEB","drug_information": {"unit": 2.5,"type": "ML"},"code_information":[{"code":"6306492","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-9801-01","type":"NDC"}],"standard_charges":[{"minimum":6.36,"maximum":9.81,"gross_charge":12,"discounted_cash":2.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"}]}]},{"description":"IPRATROP 0.02% 2.5ML NEB","drug_information": {"unit": 2.5,"type": "ML"},"code_information":[{"code":"6306492","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-9801-01","type":"NDC"}],"standard_charges":[{"minimum":1.68,"maximum":9.81,"gross_charge":12,"discounted_cash":2.75,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL 1.25MG/3ML INH SOL","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6306567","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-9904-01","type":"NDC"}],"standard_charges":[{"minimum":7.95,"maximum":12.26,"gross_charge":15,"discounted_cash":3.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL 1.25MG/3ML INH SOL","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6306567","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-9904-01","type":"NDC"}],"standard_charges":[{"minimum":2.1,"maximum":12.26,"gross_charge":15,"discounted_cash":3.44,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"}]}]},{"description":"PHARMACY - EXTENSION OF 025X - SINGLE SOURCE DRUG","code_information":[{"code":"631","type":"RC"}],"standard_charges":[{"minimum":232.83,"maximum":310.38,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":310.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":232.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":232.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE","code_information":[{"code":"6311","type":"APR-DRG"}],"standard_charges":[{"minimum":8963,"maximum":8963,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8963,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8963,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8963,"methodology":"case rate"}]}]},{"description":"LEVALBUTEROL 1.25MG/3ML NEB","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6311989","type":"CDM"},{"code":"0250","type":"RC"},{"code":"76204-0900-25","type":"NDC"}],"standard_charges":[{"minimum":9.54,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"LEVALBUTEROL 1.25MG/3ML NEB","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6311989","type":"CDM"},{"code":"0250","type":"RC"},{"code":"76204-0900-25","type":"NDC"}],"standard_charges":[{"minimum":2.52,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE","code_information":[{"code":"6312","type":"APR-DRG"}],"standard_charges":[{"minimum":20952,"maximum":20952,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20952,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20952,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20952,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE","code_information":[{"code":"6313","type":"APR-DRG"}],"standard_charges":[{"minimum":39078,"maximum":39078,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39078,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39078,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39078,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE","code_information":[{"code":"6314","type":"APR-DRG"}],"standard_charges":[{"minimum":117260,"maximum":117260,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117260,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117260,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117260,"methodology":"case rate"}]}]},{"description":"HETASTARCH 6% 30GM/500ML NS IV","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"6318612","type":"CDM"},{"code":"0258","type":"RC"},{"code":"00409-7248-03","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"HETASTARCH 6% 30GM/500ML NS IV","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"6318612","type":"CDM"},{"code":"0258","type":"RC"},{"code":"00409-7248-03","type":"NDC"}],"standard_charges":[{"minimum":49,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 30ML INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"6326045","type":"CDM"},{"code":"0258","type":"RC"},{"code":"00409-1966-07","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 30ML INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"6326045","type":"CDM"},{"code":"0258","type":"RC"},{"code":"00409-1966-07","type":"NDC"}],"standard_charges":[{"minimum":7.56,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"}]}]},{"description":"CYCLOPENTOLATE 1% 2ML OP SOL","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"6329098","type":"CDM"},{"code":"0250","type":"RC"},{"code":"61314-0396-01","type":"NDC"}],"standard_charges":[{"minimum":75.79,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"}]}]},{"description":"CYCLOPENTOLATE 1% 2ML OP SOL","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"6329098","type":"CDM"},{"code":"0250","type":"RC"},{"code":"61314-0396-01","type":"NDC"}],"standard_charges":[{"minimum":20.02,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.02,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL 90MCG 6.7GM INH","drug_information": {"unit": 6.7,"type": "GR"},"code_information":[{"code":"6330567","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00054-0742-87","type":"NDC"}],"standard_charges":[{"minimum":409.69,"maximum":631.55,"gross_charge":773,"discounted_cash":177.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":409.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":631.55,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL 90MCG 6.7GM INH","drug_information": {"unit": 6.7,"type": "GR"},"code_information":[{"code":"6330567","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00054-0742-87","type":"NDC"}],"standard_charges":[{"minimum":108.22,"maximum":631.55,"gross_charge":773,"discounted_cash":177.02,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":409.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":631.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.22,"methodology":"fee schedule"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6331","type":"APR-DRG"}],"standard_charges":[{"minimum":1813,"maximum":1813,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1813,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1813,"methodology":"case rate"}]}]},{"description":"BUDESONIDE 0.5MG/2ML AMP NEB","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"6331664","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00186-1989-04","type":"NDC"}],"standard_charges":[{"minimum":55.65,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5MG/2ML AMP NEB","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"6331664","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00186-1989-04","type":"NDC"}],"standard_charges":[{"minimum":14.7,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 10% 4ML INH SOL","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"6331755","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00517-7504-25","type":"NDC"}],"standard_charges":[{"minimum":23.32,"maximum":35.95,"gross_charge":44,"discounted_cash":10.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 10% 4ML INH SOL","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"6331755","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00517-7504-25","type":"NDC"}],"standard_charges":[{"minimum":6.16,"maximum":35.95,"gross_charge":44,"discounted_cash":10.08,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300/5ML 5ML NEB","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"6331771","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00078-0494-71","type":"NDC"}],"standard_charges":[{"minimum":643.95,"maximum":992.66,"gross_charge":1215,"discounted_cash":278.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":643.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":992.66,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300/5ML 5ML NEB","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"6331771","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00078-0494-71","type":"NDC"}],"standard_charges":[{"minimum":170.1,"maximum":992.66,"gross_charge":1215,"discounted_cash":278.24,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":643.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":992.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6332","type":"APR-DRG"}],"standard_charges":[{"minimum":6733,"maximum":6733,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6333","type":"APR-DRG"}],"standard_charges":[{"minimum":18604,"maximum":18604,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18604,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18604,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18604,"methodology":"case rate"}]}]},{"description":"BUDESONIDE 0.25MG/2ML AMP NEB","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"6333314","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00186-1988-04","type":"NDC"}],"standard_charges":[{"minimum":47.17,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.25MG/2ML AMP NEB","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"6333314","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00186-1988-04","type":"NDC"}],"standard_charges":[{"minimum":12.46,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6334","type":"APR-DRG"}],"standard_charges":[{"minimum":44230,"maximum":44230,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44230,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44230,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44230,"methodology":"case rate"}]}]},{"description":"NACL 0.9% 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"6334973","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00338-0553-18","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"6334973","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00338-0553-18","type":"NDC"}],"standard_charges":[{"minimum":49,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"ETHYL CHLORIDE 100% 103ML SPRY","drug_information": {"unit": 103,"type": "ML"},"code_information":[{"code":"6340376","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00386-0001-02","type":"NDC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"ETHYL CHLORIDE 100% 103ML SPRY","drug_information": {"unit": 103,"type": "ML"},"code_information":[{"code":"6340376","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00386-0001-02","type":"NDC"}],"standard_charges":[{"minimum":34.86,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.86,"methodology":"fee schedule"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6341","type":"APR-DRG"}],"standard_charges":[{"minimum":4202,"maximum":4202,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4202,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4202,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4202,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6342","type":"APR-DRG"}],"standard_charges":[{"minimum":8175,"maximum":8175,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8175,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8175,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8175,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6343","type":"APR-DRG"}],"standard_charges":[{"minimum":11833,"maximum":11833,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11833,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11833,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11833,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6344","type":"APR-DRG"}],"standard_charges":[{"minimum":29794,"maximum":29794,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29794,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29794,"methodology":"case rate"}]}]},{"description":"NACL 0.9% 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"6345896","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00409-4888-10","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"6345896","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00409-4888-10","type":"NDC"}],"standard_charges":[{"minimum":7.56,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6361","type":"APR-DRG"}],"standard_charges":[{"minimum":4358,"maximum":4358,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4358,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4358,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4358,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6362","type":"APR-DRG"}],"standard_charges":[{"minimum":7691,"maximum":7691,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7691,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7691,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7691,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6363","type":"APR-DRG"}],"standard_charges":[{"minimum":15457,"maximum":15457,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15457,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15457,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15457,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6364","type":"APR-DRG"}],"standard_charges":[{"minimum":27901,"maximum":27901,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27901,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27901,"methodology":"case rate"}]}]},{"description":"DIABETES WITH MCC","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":12091.24,"maximum":28586.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26030,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26030,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16121.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12091.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12091.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25185.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20768.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28586.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12534.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12660.25,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12910.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12785.6,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12534.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12534.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12534.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12848.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12534.9,"methodology":"case rate"}]}]},{"description":"NA HYPOCHLOR 0.5% 473MLTOP SOL","drug_information": {"unit": 473,"type": "ML"},"code_information":[{"code":"6376514","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00436-0946-16","type":"NDC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"NA HYPOCHLOR 0.5% 473MLTOP SOL","drug_information": {"unit": 473,"type": "ML"},"code_information":[{"code":"6376514","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00436-0946-16","type":"NDC"}],"standard_charges":[{"minimum":3.36,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"}]}]},{"description":"ALBUTER/IPRAT 2.5-0.5/3ML NEB","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6378497","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-0201-01","type":"NDC"}],"standard_charges":[{"minimum":10.07,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"ALBUTER/IPRAT 2.5-0.5/3ML NEB","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6378497","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00487-0201-01","type":"NDC"}],"standard_charges":[{"minimum":2.66,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"}]}]},{"description":"BARIUM 40% 148GM PWD FOR LIQ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6378874","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0105-10","type":"NDC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"BARIUM 40% 148GM PWD FOR LIQ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6378874","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0105-10","type":"NDC"}],"standard_charges":[{"minimum":8.82,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"}]}]},{"description":"BARIUM 40% 30ML PASTE/PUDDING","drug_information": {"unit": 230,"type": "ML"},"code_information":[{"code":"6378875","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0125-22","type":"NDC"}],"standard_charges":[{"minimum":283.55,"maximum":437.1,"gross_charge":535,"discounted_cash":122.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"}]}]},{"description":"BARIUM 40% 30ML PASTE/PUDDING","drug_information": {"unit": 230,"type": "ML"},"code_information":[{"code":"6378875","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0125-22","type":"NDC"}],"standard_charges":[{"minimum":74.9,"maximum":437.1,"gross_charge":535,"discounted_cash":122.52,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"}]}]},{"description":"BARIUM 40% W/V 240ML NECTAR","drug_information": {"unit": 240,"type": "ML"},"code_information":[{"code":"6378876","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0116-00","type":"NDC"}],"standard_charges":[{"minimum":77.91,"maximum":120.1,"gross_charge":147,"discounted_cash":33.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.1,"methodology":"fee schedule"}]}]},{"description":"BARIUM 40% W/V 240ML NECTAR","drug_information": {"unit": 240,"type": "ML"},"code_information":[{"code":"6378876","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0116-00","type":"NDC"}],"standard_charges":[{"minimum":20.58,"maximum":120.1,"gross_charge":147,"discounted_cash":33.67,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"}]}]},{"description":"BARIUM 40% W/V 250ML HONEY SUS","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"6378877","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0121-07","type":"NDC"}],"standard_charges":[{"minimum":2.12,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"BARIUM 40% W/V 250ML HONEY SUS","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"6378877","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0121-07","type":"NDC"}],"standard_charges":[{"minimum":0.56,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"}]}]},{"description":"BARIUM SULFATE 700MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6378880","type":"CDM"},{"code":"0255","type":"RC"},{"code":"10361-0778-31","type":"NDC"}],"standard_charges":[{"minimum":13.25,"maximum":20.43,"gross_charge":25,"discounted_cash":5.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"}]}]},{"description":"BARIUM SULFATE 700MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6378880","type":"CDM"},{"code":"0255","type":"RC"},{"code":"10361-0778-31","type":"NDC"}],"standard_charges":[{"minimum":3.5,"maximum":20.43,"gross_charge":25,"discounted_cash":5.73,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"}]}]},{"description":"BARIUM SULFATE 24% 600ML SUS","drug_information": {"unit": 600,"type": "ML"},"code_information":[{"code":"6378882","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0145-06","type":"NDC"}],"standard_charges":[{"minimum":87.98,"maximum":135.63,"gross_charge":166,"discounted_cash":38.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.63,"methodology":"fee schedule"}]}]},{"description":"BARIUM SULFATE 24% 600ML SUS","drug_information": {"unit": 600,"type": "ML"},"code_information":[{"code":"6378882","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0145-06","type":"NDC"}],"standard_charges":[{"minimum":23.24,"maximum":135.63,"gross_charge":166,"discounted_cash":38.02,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.24,"methodology":"fee schedule"}]}]},{"description":"BARIUM SULF 98% W/W 135ML SUSP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6378930","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0764-01","type":"NDC"}],"standard_charges":[{"minimum":32.86,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"}]}]},{"description":"BARIUM SULF 98% W/W 135ML SUSP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6378930","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0764-01","type":"NDC"}],"standard_charges":[{"minimum":8.68,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"}]}]},{"description":"DERMABOND ADHES APPL TOP","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"6379046","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00400-0348-12","type":"NDC"}],"standard_charges":[{"minimum":135.68,"maximum":209.16,"gross_charge":256,"discounted_cash":58.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.16,"methodology":"fee schedule"}]}]},{"description":"DERMABOND ADHES APPL TOP","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"6379046","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00400-0348-12","type":"NDC"}],"standard_charges":[{"minimum":35.84,"maximum":209.16,"gross_charge":256,"discounted_cash":58.63,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"}]}]},{"description":"BARIUM SULF 60% W/V 355ML SUSP","drug_information": {"unit": 355,"type": "ML"},"code_information":[{"code":"6379226","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0187-02","type":"NDC"}],"standard_charges":[{"minimum":30.21,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"}]}]},{"description":"BARIUM SULF 60% W/V 355ML SUSP","drug_information": {"unit": 355,"type": "ML"},"code_information":[{"code":"6379226","type":"CDM"},{"code":"0255","type":"RC"},{"code":"32909-0187-02","type":"NDC"}],"standard_charges":[{"minimum":7.98,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE HEMOSTAT 2X3 1PAD","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6379558","type":"CDM"},{"code":"0250","type":"RC"},{"code":"63713-0019-53","type":"NDC"}],"standard_charges":[{"minimum":154.23,"maximum":237.75,"gross_charge":291,"discounted_cash":66.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.75,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE HEMOSTAT 2X3 1PAD","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6379558","type":"CDM"},{"code":"0250","type":"RC"},{"code":"63713-0019-53","type":"NDC"}],"standard_charges":[{"minimum":40.74,"maximum":237.75,"gross_charge":291,"discounted_cash":66.64,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.74,"methodology":"fee schedule"}]}]},{"description":"DIABETES WITH CC","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":8366.02,"maximum":18238.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16607,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16607,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13553.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10165.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10165.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16068.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13250.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18238.98,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8366.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8449.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8617.01,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8533.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8366.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8366.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8366.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8575.18,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8366.02,"methodology":"case rate"}]}]},{"description":"LET 4-0.05-0.5 3ML TOP SOL PFS","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6380974","type":"CDM"},{"code":"0250","type":"RC"},{"code":"70092-1658-44","type":"NDC"}],"standard_charges":[{"minimum":53.53,"maximum":82.52,"gross_charge":101,"discounted_cash":23.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.52,"methodology":"fee schedule"}]}]},{"description":"LET 4-0.05-0.5 3ML TOP SOL PFS","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"6380974","type":"CDM"},{"code":"0250","type":"RC"},{"code":"70092-1658-44","type":"NDC"}],"standard_charges":[{"minimum":14.14,"maximum":82.52,"gross_charge":101,"discounted_cash":23.13,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"}]}]},{"description":"BARICITINIB 2MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6381635","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00002-4182-30","type":"NDC"}],"standard_charges":[{"minimum":385.31,"maximum":593.96,"gross_charge":727,"discounted_cash":166.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":385.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":593.96,"methodology":"fee schedule"}]}]},{"description":"BARICITINIB 2MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6381635","type":"CDM"},{"code":"0250","type":"RC"},{"code":"00002-4182-30","type":"NDC"}],"standard_charges":[{"minimum":101.78,"maximum":593.96,"gross_charge":727,"discounted_cash":166.49,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":385.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":593.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.78,"methodology":"fee schedule"}]}]},{"description":"CLOSURE EXTERN","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6381952","type":"CDM"},{"code":"0272","type":"RC"},{"code":"10036-1600-00","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":1.64,"gross_charge":2,"discounted_cash":0.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"}]}]},{"description":"CLOSURE EXTERN","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"6381952","type":"CDM"},{"code":"0272","type":"RC"},{"code":"10036-1600-00","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":1.64,"gross_charge":2,"discounted_cash":0.46,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"}]}]},{"description":"DIABETES WITHOUT CC/MCC","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":6118.81,"maximum":18772.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11518,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11518,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18772.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14079.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14079.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11144.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9190.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12650.31,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6118.81,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6180,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6302.38,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6241.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6118.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6118.81,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6118.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6271.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6118.81,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6391","type":"APR-DRG"}],"standard_charges":[{"minimum":3730,"maximum":3730,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3730,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3730,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3730,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6392","type":"APR-DRG"}],"standard_charges":[{"minimum":7330,"maximum":7330,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7330,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7330,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7330,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6393","type":"APR-DRG"}],"standard_charges":[{"minimum":12642,"maximum":12642,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12642,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12642,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12642,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6394","type":"APR-DRG"}],"standard_charges":[{"minimum":16825,"maximum":16825,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16825,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16825,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16825,"methodology":"case rate"}]}]},{"description":"HOME IV THERAPY SERVICES - GENERAL","code_information":[{"code":"640","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MISCELLANEOUS DISORDERS OF NUTRITION METABOLISM FLUIDS AND ELECTROLYTES WITH MCC","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"minimum":10422.14,"maximum":25048.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22808,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22808,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13895.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10422.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10422.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22068.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18198.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25048.94,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11542.75,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11658.18,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11889.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11773.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11542.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11542.75,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11542.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11831.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11542.75,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6401","type":"APR-DRG"}],"standard_charges":[{"minimum":658,"maximum":658,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":658,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":658,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":658,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6402","type":"APR-DRG"}],"standard_charges":[{"minimum":958,"maximum":958,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":958,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":958,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":958,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6403","type":"APR-DRG"}],"standard_charges":[{"minimum":2237,"maximum":2237,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2237,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2237,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2237,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6404","type":"APR-DRG"}],"standard_charges":[{"minimum":16672,"maximum":16672,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16672,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16672,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16672,"methodology":"case rate"}]}]},{"description":"HOME IV THERAPY SERVICES - NONROUTINE NURSING CENTRAL LINE","code_information":[{"code":"641","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MISCELLANEOUS DISORDERS OF NUTRITION METABOLISM FLUIDS AND ELECTROLYTES WITHOUT MCC","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"minimum":7315.88,"maximum":17239.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14212,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14212,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17239.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12929.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12929.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13751.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11339.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15608.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7389.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7535.36,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7462.2,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7498.78,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"}]}]},{"description":"HOME IV THERAPY SERVICES - IV SITE CARE CENTRAL LINE","code_information":[{"code":"642","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INBORN AND OTHER DISORDERS OF METABOLISM","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"minimum":10870.75,"maximum":25853.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22838,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22838,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25853.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19390.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19390.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22097.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18222.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25081.95,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10870.75,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10979.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11196.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11088.17,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10870.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10870.75,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10870.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11142.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10870.75,"methodology":"case rate"}]}]},{"description":"ENDOCRINE DISORDERS WITH MCC","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"minimum":14089.23,"maximum":33534.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30535,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30535,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19748.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14811.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14811.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29543.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24362.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33534.06,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14089.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14230.13,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14511.91,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14371.02,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14089.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14089.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14089.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14441.47,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14089.23,"methodology":"case rate"}]}]},{"description":"HOME IV THERAPY SERVICES - IV START/CHANGE PERIPHERAL LINE","code_information":[{"code":"643","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENDOCRINE DISORDERS WITH CC","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"minimum":9264.6,"maximum":21209.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19312,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19312,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15425.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11569.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11569.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18685.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15409.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21209.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9264.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9357.25,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9542.54,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9449.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9264.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9264.6,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9264.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9496.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9264.6,"methodology":"case rate"}]}]},{"description":"HOME IV THERAPY SERVICES - NONROUTINE NURSING PERIPHERAL LINE","code_information":[{"code":"644","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENDOCRINE DISORDERS WITHOUT CC/MCC","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"minimum":7295,"maximum":109243,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14374,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14374,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109243,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81933.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81933.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13907.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11468.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15786.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7295,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7367.95,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7513.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7440.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7295,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7295,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7295,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7477.38,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7295,"methodology":"case rate"}]}]},{"description":"HOME IV THERAPY SERVICES - TRAINING PATIENT/CARE GIVER CENTRAL LINE","code_information":[{"code":"645","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HOME IV THERAPY SERVICES - TRAINING DISABLED PATIENT CENTRAL LINE","code_information":[{"code":"646","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HOME IV THERAPY SERVICES - TRAINING PATIENT/CARE GIVER PERIPHERAL","code_information":[{"code":"647","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HOME IV THERAPY SERVICES - TRAINING DISABLED PATIENT PERIPHERAL","code_information":[{"code":"648","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HOME IV THERAPY SERVICES - OTHER IV THERAPY SERVICES","code_information":[{"code":"649","type":"RC"}],"standard_charges":[{"minimum":341.09,"maximum":454.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":341.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"minimum":36901.64,"maximum":89684.89,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89684.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":67264.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":67264.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":36901.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":37270.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38008.69,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":37639.68,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":36901.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":36901.64,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":36901.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":37824.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":36901.64,"methodology":"case rate"}]}]},{"description":"SPLENECTOMY","code_information":[{"code":"6501","type":"APR-DRG"}],"standard_charges":[{"minimum":8638,"maximum":8638,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8638,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8638,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8638,"methodology":"case rate"}]}]},{"description":"SPLENECTOMY","code_information":[{"code":"6502","type":"APR-DRG"}],"standard_charges":[{"minimum":11118,"maximum":11118,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11118,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11118,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11118,"methodology":"case rate"}]}]},{"description":"SPLENECTOMY","code_information":[{"code":"6503","type":"APR-DRG"}],"standard_charges":[{"minimum":18285,"maximum":18285,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18285,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18285,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18285,"methodology":"case rate"}]}]},{"description":"SPLENECTOMY","code_information":[{"code":"6504","type":"APR-DRG"}],"standard_charges":[{"minimum":27308,"maximum":27308,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27308,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27308,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27308,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"minimum":28126.21,"maximum":77311.82,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77311.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57984.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57984.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28126.21,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28407.48,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28970,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28688.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28126.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28126.21,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28126.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28829.37,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28126.21,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6511","type":"APR-DRG"}],"standard_charges":[{"minimum":6620,"maximum":6620,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6620,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6620,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6620,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6512","type":"APR-DRG"}],"standard_charges":[{"minimum":9400,"maximum":9400,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9400,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9400,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9400,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6513","type":"APR-DRG"}],"standard_charges":[{"minimum":16411,"maximum":16411,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16411,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16411,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16411,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6514","type":"APR-DRG"}],"standard_charges":[{"minimum":44101,"maximum":44101,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44101,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44101,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44101,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"minimum":25024.49,"maximum":100379.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63585,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63585,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100379.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":75285.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":75285.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":61520.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":50732.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":69830.48,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25024.49,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25274.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25775.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25524.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25024.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25024.49,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25024.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25650.11,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25024.49,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITH MCC","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"minimum":44381.79,"maximum":114217.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104003,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104003,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69964.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52474.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52474.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":100625.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":82981.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":114217.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":44381.79,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":44825.61,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":45713.25,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":45269.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":44381.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":44381.79,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":44381.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":45491.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":44381.79,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITH CC","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"minimum":23096.65,"maximum":59456.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52827,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52827,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59456.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44593.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44593.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":51111.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":42149.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":58015.68,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23096.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23327.62,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23789.55,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23558.59,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23096.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23096.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23096.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23674.07,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23096.65,"methodology":"case rate"}]}]},{"description":"HOSPICE SERVICE - INPATIENT RESPITE CARE","code_information":[{"code":"655","type":"RC"}],"standard_charges":[{"minimum":898.1,"maximum":1197.27,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1197.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":898.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":898.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR BLADDER PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"minimum":17337.1,"maximum":61193.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38742,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38742,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61193.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45896.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45896.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37484.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30911.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42547.31,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17337.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17510.48,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17857.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17683.85,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17337.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17337.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17337.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17770.53,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17337.1,"methodology":"case rate"}]}]},{"description":"HOSPICE SERVICE - GENERAL INPATIENT CARE NON-RESPITE","code_information":[{"code":"656","type":"RC"}],"standard_charges":[{"minimum":2025.15,"maximum":2699.75,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2699.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2025.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2025.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"minimum":26467.48,"maximum":67266.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61250,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61250,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43698.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32774.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32774.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":59261.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":48869.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":67266.17,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26467.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26732.16,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27261.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26996.83,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26467.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26467.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26467.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27129.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26467.48,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"minimum":15410.03,"maximum":39902.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36333,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36333,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38081.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28561.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28561.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35154.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28989.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39902.54,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15410.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15564.14,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15872.34,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15718.24,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15410.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15410.03,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15410.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15795.29,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15410.03,"methodology":"case rate"}]}]},{"description":"HOSPICE SERVICE - HOSPICE ROOM & BOARD-NURSING FACILITY","code_information":[{"code":"658","type":"RC"}],"standard_charges":[{"minimum":1207.16,"maximum":1609.27,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1609.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1207.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1207.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"minimum":12903.76,"maximum":54746.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29490,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29490,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54746.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41060.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41060.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28532.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23529.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32387.03,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12903.76,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13032.8,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13290.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13161.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12903.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12903.76,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12903.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13226.36,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12903.76,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"minimum":21257.74,"maximum":55284.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50340,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50340,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40116.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30087.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30087.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":48705.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":40164.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":55284.27,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21257.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21470.32,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21895.48,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21682.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21257.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21257.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21257.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21789.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21257.74,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"minimum":11635.55,"maximum":29309.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26687,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26687,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27265.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20449.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20449.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25821.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21293.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29309.04,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11635.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11751.91,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11984.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11868.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11635.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11635.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11635.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11926.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11635.55,"methodology":"case rate"}]}]},{"description":"RESPITE CARE - GENERAL","code_information":[{"code":"660","type":"RC"}],"standard_charges":[{"minimum":211.06,"maximum":281.36,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION","code_information":[{"code":"6601","type":"APR-DRG"}],"standard_charges":[{"minimum":4430,"maximum":4430,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4430,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4430,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4430,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION","code_information":[{"code":"6602","type":"APR-DRG"}],"standard_charges":[{"minimum":5101,"maximum":5101,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5101,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5101,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5101,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION","code_information":[{"code":"6603","type":"APR-DRG"}],"standard_charges":[{"minimum":8723,"maximum":8723,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8723,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8723,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION","code_information":[{"code":"6604","type":"APR-DRG"}],"standard_charges":[{"minimum":23112,"maximum":23112,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23112,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23112,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23112,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"minimum":9212.02,"maximum":43411.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20477,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20477,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43411.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32559.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32559.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19812.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16338.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22488.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9212.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9304.15,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9488.39,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9396.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9212.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9212.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9212.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9442.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9212.02,"methodology":"case rate"}]}]},{"description":"RESPITE CARE - HOURLY CHARGE - NURSING","code_information":[{"code":"661","type":"RC"}],"standard_charges":[{"minimum":211.06,"maximum":281.36,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COAGULATION AND PLATELET DISORDERS","code_information":[{"code":"6611","type":"APR-DRG"}],"standard_charges":[{"minimum":5231,"maximum":5231,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5231,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5231,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5231,"methodology":"case rate"}]}]},{"description":"COAGULATION AND PLATELET DISORDERS","code_information":[{"code":"6612","type":"APR-DRG"}],"standard_charges":[{"minimum":6809,"maximum":6809,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6809,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6809,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6809,"methodology":"case rate"}]}]},{"description":"COAGULATION AND PLATELET DISORDERS","code_information":[{"code":"6613","type":"APR-DRG"}],"standard_charges":[{"minimum":9940,"maximum":9940,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9940,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9940,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9940,"methodology":"case rate"}]}]},{"description":"COAGULATION AND PLATELET DISORDERS","code_information":[{"code":"6614","type":"APR-DRG"}],"standard_charges":[{"minimum":20370,"maximum":20370,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20370,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20370,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20370,"methodology":"case rate"}]}]},{"description":"MINOR BLADDER PROCEDURES WITH MCC","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"minimum":22778.15,"maximum":65287.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59448,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59448,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30370.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22778.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22778.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":57518.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47432.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65287.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25397.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25651.21,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26159.15,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25905.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25397.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25397.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25397.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26032.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25397.23,"methodology":"case rate"}]}]},{"description":"RESPITE CARE - HOURLY CHARGE/AIDE/HOMEMAKER/COMPANION","code_information":[{"code":"662","type":"RC"}],"standard_charges":[{"minimum":211.06,"maximum":281.36,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SICKLE CELL ANEMIA CRISIS","code_information":[{"code":"6621","type":"APR-DRG"}],"standard_charges":[{"minimum":3519,"maximum":3519,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3519,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3519,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3519,"methodology":"case rate"}]}]},{"description":"SICKLE CELL ANEMIA CRISIS","code_information":[{"code":"6622","type":"APR-DRG"}],"standard_charges":[{"minimum":4724,"maximum":4724,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4724,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4724,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4724,"methodology":"case rate"}]}]},{"description":"SICKLE CELL ANEMIA CRISIS","code_information":[{"code":"6623","type":"APR-DRG"}],"standard_charges":[{"minimum":7134,"maximum":7134,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7134,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7134,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7134,"methodology":"case rate"}]}]},{"description":"SICKLE CELL ANEMIA CRISIS","code_information":[{"code":"6624","type":"APR-DRG"}],"standard_charges":[{"minimum":15660,"maximum":15660,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15660,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15660,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15660,"methodology":"case rate"}]}]},{"description":"MINOR BLADDER PROCEDURES WITH CC","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"minimum":13084.71,"maximum":31427.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28617,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28617,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22133.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16600.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16600.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27687.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22832.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31427.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13084.71,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13215.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13477.26,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13346.41,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13084.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13084.71,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13084.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13411.83,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13084.71,"methodology":"case rate"}]}]},{"description":"OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6631","type":"APR-DRG"}],"standard_charges":[{"minimum":3267,"maximum":3267,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3267,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3267,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3267,"methodology":"case rate"}]}]},{"description":"OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6632","type":"APR-DRG"}],"standard_charges":[{"minimum":4240,"maximum":4240,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4240,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4240,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4240,"methodology":"case rate"}]}]},{"description":"OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6633","type":"APR-DRG"}],"standard_charges":[{"minimum":6009,"maximum":6009,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6009,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6009,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6009,"methodology":"case rate"}]}]},{"description":"OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6634","type":"APR-DRG"}],"standard_charges":[{"minimum":10567,"maximum":10567,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10567,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10567,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10567,"methodology":"case rate"}]}]},{"description":"MINOR BLADDER PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"minimum":9623.41,"maximum":42269.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20787,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20787,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42269.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31702.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31702.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20112.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16585.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22829.15,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9623.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9719.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9912.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9815.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9623.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9623.41,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9623.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9864,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9623.41,"methodology":"case rate"}]}]},{"description":"PROSTATECTOMY WITH MCC","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"minimum":21770.97,"maximum":61240.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55763,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55763,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29027.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21770.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21770.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":53952.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":44491.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61240.15,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27825.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28103.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28660.16,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28381.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27825.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27825.39,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27825.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28521.03,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27825.39,"methodology":"case rate"}]}]},{"description":"PROSTATECTOMY WITH CC","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"minimum":13833.02,"maximum":36496.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33232,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33232,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18443.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13833.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13833.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32153.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26515.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36496.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14011.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14152.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14432.26,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14292.14,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14011.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14011.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14011.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14362.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14011.9,"methodology":"case rate"}]}]},{"description":"PROSTATECTOMY WITHOUT CC/MCC","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"minimum":9221.3,"maximum":36811.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17633,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17633,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36811.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27608.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27608.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17060.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14069.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19365.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9221.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9313.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9497.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9405.73,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9221.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9221.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9221.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9451.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9221.3,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITH MCC","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"minimum":19380.24,"maximum":57522.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52378,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52378,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25839.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19380.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19380.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":50677.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":41791.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":57522.62,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23825.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24063.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24539.86,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24301.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23825.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23825.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23825.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24420.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23825.1,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITH CC","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"minimum":13240.15,"maximum":31887.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29035,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29035,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18907.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14180.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14180.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28093.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23166.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31887.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13240.15,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13372.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13637.36,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13504.96,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13240.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13240.15,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13240.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13571.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13240.15,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"minimum":8663.75,"maximum":27822.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18384,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18384,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27822.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20867.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20867.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17787.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14668.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20190.58,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8663.75,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8750.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8923.67,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8837.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8663.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8663.75,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8663.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8880.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8663.75,"methodology":"case rate"}]}]},{"description":"URETHRAL PROCEDURES WITH CC/MCC","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"minimum":13721.4,"maximum":37703.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34331,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34331,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18294.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13721.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13721.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33216.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27392.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37703.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14602.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14748.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15040.79,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14894.76,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14602.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14602.7,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14602.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14967.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14602.7,"methodology":"case rate"}]}]},{"description":"URETHRAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"minimum":9736.32,"maximum":40836.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19408,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19408,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40836.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30627.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30627.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18778.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15485.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21314.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9736.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9833.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10028.41,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9931.05,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9736.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9736.32,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9736.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9979.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9736.32,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"minimum":23816.47,"maximum":73743.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67148,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67148,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31754.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23816.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23816.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":64968.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":53576.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":73743.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33671.56,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34008.28,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34681.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34345,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33671.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33671.56,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33671.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34513.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33671.56,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"minimum":19124.2,"maximum":50423.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45914,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45914,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28075.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21057.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21057.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":44423.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36633.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50423.84,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19124.2,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19315.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19697.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19506.69,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19124.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19124.2,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19124.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19602.31,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19124.2,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"minimum":13377.79,"maximum":33668.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30657,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30657,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30460.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22845.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22845.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29661.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24460.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33668.16,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13377.79,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13511.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13779.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13645.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13377.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13377.79,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13377.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13712.24,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13377.79,"methodology":"case rate"}]}]},{"description":"MAJOR O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6801","type":"APR-DRG"}],"standard_charges":[{"minimum":9868,"maximum":9868,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9868,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9868,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9868,"methodology":"case rate"}]}]},{"description":"MAJOR O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6802","type":"APR-DRG"}],"standard_charges":[{"minimum":13982,"maximum":13982,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13982,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13982,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13982,"methodology":"case rate"}]}]},{"description":"MAJOR O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6803","type":"APR-DRG"}],"standard_charges":[{"minimum":22837,"maximum":22837,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22837,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22837,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22837,"methodology":"case rate"}]}]},{"description":"MAJOR O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6804","type":"APR-DRG"}],"standard_charges":[{"minimum":48686,"maximum":48686,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48686,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48686,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48686,"methodology":"case rate"}]}]},{"description":"TRAUMA RESPONSE - LEVEL 1","code_information":[{"code":"681","type":"RC"}],"standard_charges":[{"minimum":7088.74,"maximum":9450.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9450.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7088.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7088.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER  O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6811","type":"APR-DRG"}],"standard_charges":[{"minimum":7456,"maximum":7456,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7456,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7456,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7456,"methodology":"case rate"}]}]},{"description":"OTHER  O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6812","type":"APR-DRG"}],"standard_charges":[{"minimum":10551,"maximum":10551,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10551,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10551,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10551,"methodology":"case rate"}]}]},{"description":"OTHER  O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6813","type":"APR-DRG"}],"standard_charges":[{"minimum":18953,"maximum":18953,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18953,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18953,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18953,"methodology":"case rate"}]}]},{"description":"OTHER  O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6814","type":"APR-DRG"}],"standard_charges":[{"minimum":43042,"maximum":43042,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43042,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43042,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43042,"methodology":"case rate"}]}]},{"description":"RENAL FAILURE WITH MCC","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":12887.52,"maximum":30491.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27764,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27764,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23254.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17441.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17441.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26862.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22152.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30491.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12887.52,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13016.4,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13274.15,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13145.28,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12887.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12887.52,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12887.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13209.71,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12887.52,"methodology":"case rate"}]}]},{"description":"TRAUMA RESPONSE - LEVEL 2","code_information":[{"code":"682","type":"RC"}],"standard_charges":[{"minimum":3037.18,"maximum":4048.89,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4048.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3037.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3037.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RENAL FAILURE WITH CC","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":8147.18,"maximum":19153.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16855,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16855,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19153.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14365.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14365.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16308.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13448.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18511.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8147.18,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8228.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8391.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8310.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8147.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8147.18,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8147.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8350.86,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8147.18,"methodology":"case rate"}]}]},{"description":"TRAUMA RESPONSE - LEVEL 3","code_information":[{"code":"683","type":"RC"}],"standard_charges":[{"minimum":1518.59,"maximum":2024.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2024.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1518.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1518.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RENAL FAILURE WITHOUT CC/MCC","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":5970.34,"maximum":25223.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11558,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11558,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25223.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18918.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18918.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11183.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9222.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12693.63,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5970.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6030.05,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6149.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6089.75,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5970.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5970.34,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5970.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6119.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5970.34,"methodology":"case rate"}]}]},{"description":"TRAUMA RESPONSE - LEVEL 4","code_information":[{"code":"684","type":"RC"}],"standard_charges":[{"minimum":919.46,"maximum":1225.74,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1225.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"minimum":14531.29,"maximum":36228.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32988,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32988,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19374.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14531.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14531.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31917.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26320.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36228.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15855.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16014.01,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16331.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16172.56,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15855.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15855.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15855.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16251.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15855.45,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT NEOPLASMS WITH CC","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"minimum":9413.85,"maximum":21715.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19773,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19773,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14906.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11180.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11180.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19131,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15776.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21715.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9413.85,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9507.99,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9696.27,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9602.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9413.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9413.85,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9413.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9649.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9413.85,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"minimum":6873.55,"maximum":20070.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14488,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14488,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20070.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15053.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15053.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14018.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11560.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15911.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6873.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6942.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7079.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7011.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6873.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6873.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6873.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7045.39,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6873.55,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS WITH MCC","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":10323.25,"maximum":23076.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21012,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21012,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15166.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11374.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11374.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20330.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16765.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23076.71,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10323.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10426.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10632.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10529.72,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10323.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10323.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10323.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10581.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10323.25,"methodology":"case rate"}]}]},{"description":"TRAUMA RESPONSE - OTHER TRAUMA RESPONSE","code_information":[{"code":"689","type":"RC"}],"standard_charges":[{"minimum":919.46,"maximum":1225.74,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1225.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":7479.82,"maximum":20817.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14855,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14855,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20817.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15613.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15613.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14372.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11852.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16314.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7479.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7554.62,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7704.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7629.42,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7479.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7479.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7479.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7666.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7479.82,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA","code_information":[{"code":"6901","type":"APR-DRG"}],"standard_charges":[{"minimum":8395,"maximum":8395,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8395,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8395,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8395,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA","code_information":[{"code":"6902","type":"APR-DRG"}],"standard_charges":[{"minimum":14101,"maximum":14101,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14101,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14101,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14101,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA","code_information":[{"code":"6903","type":"APR-DRG"}],"standard_charges":[{"minimum":28763,"maximum":28763,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28763,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28763,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28763,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA","code_information":[{"code":"6904","type":"APR-DRG"}],"standard_charges":[{"minimum":46114,"maximum":46114,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46114,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46114,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46114,"methodology":"case rate"}]}]},{"description":"LYMPHOMA MYELOMA AND NON-ACUTE LEUKEMIA","code_information":[{"code":"6911","type":"APR-DRG"}],"standard_charges":[{"minimum":6508,"maximum":6508,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6508,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6508,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6508,"methodology":"case rate"}]}]},{"description":"LYMPHOMA MYELOMA AND NON-ACUTE LEUKEMIA","code_information":[{"code":"6912","type":"APR-DRG"}],"standard_charges":[{"minimum":8189,"maximum":8189,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8189,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8189,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8189,"methodology":"case rate"}]}]},{"description":"LYMPHOMA MYELOMA AND NON-ACUTE LEUKEMIA","code_information":[{"code":"6913","type":"APR-DRG"}],"standard_charges":[{"minimum":13032,"maximum":13032,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13032,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13032,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13032,"methodology":"case rate"}]}]},{"description":"LYMPHOMA MYELOMA AND NON-ACUTE LEUKEMIA","code_information":[{"code":"6914","type":"APR-DRG"}],"standard_charges":[{"minimum":26742,"maximum":26742,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26742,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26742,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26742,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"6921","type":"APR-DRG"}],"standard_charges":[{"minimum":5057,"maximum":5057,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"6922","type":"APR-DRG"}],"standard_charges":[{"minimum":9311,"maximum":9311,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9311,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9311,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9311,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"6923","type":"APR-DRG"}],"standard_charges":[{"minimum":15238,"maximum":15238,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15238,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15238,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15238,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"6924","type":"APR-DRG"}],"standard_charges":[{"minimum":24535,"maximum":24535,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24535,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24535,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24535,"methodology":"case rate"}]}]},{"description":"URINARY STONES WITH MCC","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"minimum":10614.23,"maximum":27918.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25421,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25421,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14152.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10614.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10614.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24596.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20283.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27918.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12643.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12770.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13023.25,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12896.81,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12643.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12643.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12643.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12960.03,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12643.93,"methodology":"case rate"}]}]},{"description":"URINARY STONES WITHOUT MCC","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"minimum":7315.88,"maximum":17529.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13908,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13908,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17529.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13147.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13147.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13456.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11097.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15274.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7389.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7535.36,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7462.2,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7498.78,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7315.88,"methodology":"case rate"}]}]},{"description":"LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR","code_information":[{"code":"6941","type":"APR-DRG"}],"standard_charges":[{"minimum":4156,"maximum":4156,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4156,"methodology":"case rate"}]}]},{"description":"LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR","code_information":[{"code":"6942","type":"APR-DRG"}],"standard_charges":[{"minimum":5435,"maximum":5435,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5435,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5435,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5435,"methodology":"case rate"}]}]},{"description":"LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR","code_information":[{"code":"6943","type":"APR-DRG"}],"standard_charges":[{"minimum":8225,"maximum":8225,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8225,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8225,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8225,"methodology":"case rate"}]}]},{"description":"LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR","code_information":[{"code":"6944","type":"APR-DRG"}],"standard_charges":[{"minimum":15696,"maximum":15696,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15696,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15696,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15696,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"minimum":8758.23,"maximum":24184.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22021,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22021,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11677.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8758.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8758.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21306.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17570.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24184.54,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9994.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10094.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10294.44,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10194.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9994.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9994.6,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9994.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10244.47,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9994.6,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY FOR ACUTE LEUKEMIA","code_information":[{"code":"6951","type":"APR-DRG"}],"standard_charges":[{"minimum":5871,"maximum":5871,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY FOR ACUTE LEUKEMIA","code_information":[{"code":"6952","type":"APR-DRG"}],"standard_charges":[{"minimum":5871,"maximum":5871,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY FOR ACUTE LEUKEMIA","code_information":[{"code":"6953","type":"APR-DRG"}],"standard_charges":[{"minimum":15441,"maximum":15441,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15441,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15441,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15441,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY FOR ACUTE LEUKEMIA","code_information":[{"code":"6954","type":"APR-DRG"}],"standard_charges":[{"minimum":42081,"maximum":42081,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42081,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42081,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"minimum":6623,"maximum":15397.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12762,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12762,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15397.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11548.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11548.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12348.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10182.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14016.02,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6623,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6689.23,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6821.69,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6755.46,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6623,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6623,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6623,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6788.58,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6623,"methodology":"case rate"}]}]},{"description":"OTHER CHEMOTHERAPY","code_information":[{"code":"6961","type":"APR-DRG"}],"standard_charges":[{"minimum":4860,"maximum":4860,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4860,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4860,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4860,"methodology":"case rate"}]}]},{"description":"OTHER CHEMOTHERAPY","code_information":[{"code":"6962","type":"APR-DRG"}],"standard_charges":[{"minimum":6172,"maximum":6172,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6172,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6172,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6172,"methodology":"case rate"}]}]},{"description":"OTHER CHEMOTHERAPY","code_information":[{"code":"6963","type":"APR-DRG"}],"standard_charges":[{"minimum":10535,"maximum":10535,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10535,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10535,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10535,"methodology":"case rate"}]}]},{"description":"OTHER CHEMOTHERAPY","code_information":[{"code":"6964","type":"APR-DRG"}],"standard_charges":[{"minimum":24622,"maximum":24622,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24622,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24622,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24622,"methodology":"case rate"}]}]},{"description":"URETHRAL STRICTURE","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"minimum":9020.24,"maximum":27705.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18294,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18294,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27705.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20779.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20779.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17700.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14596.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20091.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9020.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9110.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9290.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9200.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9020.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9020.24,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9020.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9245.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9020.24,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":14271.73,"maximum":33391.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30405,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30405,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22032.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16524.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16524.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29418.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24259.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33391.71,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14271.73,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14414.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14699.89,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14557.17,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14271.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14271.73,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14271.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14628.53,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14271.73,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":9160.21,"maximum":21304.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19399,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19399,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17519.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13139.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13139.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18769.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15478.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21304.6,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9251.82,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9435.02,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9343.42,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9389.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"}]}]},{"description":"CAST ROOM","code_information":[{"code":"700","type":"RC"}],"standard_charges":[{"minimum":293.63,"maximum":391.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":293.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"minimum":6641.56,"maximum":40254.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13932,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13932,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40254.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30191.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30191.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13480.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11116.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15301.27,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6641.56,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6707.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6840.81,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6774.4,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6641.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6641.56,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6641.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6807.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6641.56,"methodology":"case rate"}]}]},{"description":"CT HEAD W CON","code_information":[{"code":"70460","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":159.85,"maximum":3982.88,"gross_charge":4875,"discounted_cash":1116.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":333.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":333.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2583.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3982.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT HEAD WO AND W CON","code_information":[{"code":"70470","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":3123.82,"maximum":4815.4,"gross_charge":5894,"discounted_cash":1349.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3123.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4815.4,"methodology":"fee schedule"}]}]},{"description":"CT HEAD WO AND W CON","code_information":[{"code":"70470","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":187.03,"maximum":4815.4,"gross_charge":5894,"discounted_cash":1349.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":528.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":396.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":396.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3123.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4815.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ORBIT/SELLA/FOSSA/EAR WO","code_information":[{"code":"70480","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2034.14,"maximum":3135.65,"gross_charge":3838,"discounted_cash":878.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2034.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3135.65,"methodology":"fee schedule"}]}]},{"description":"CT ORBIT/SELLA/FOSSA/EAR WO","code_information":[{"code":"70480","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":3135.65,"gross_charge":3838,"discounted_cash":878.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":459.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":344.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":344.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2034.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3135.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT ORBIT/SELLA/FOSSA/EAR W CON","code_information":[{"code":"70481","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2177.24,"maximum":3356.24,"gross_charge":4108,"discounted_cash":940.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2177.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3356.24,"methodology":"fee schedule"}]}]},{"description":"CT ORBIT/SELLA/FOSSA/EAR W CON","code_information":[{"code":"70481","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":3356.24,"gross_charge":4108,"discounted_cash":940.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":591.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":443.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":443.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2177.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3356.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ORBIT/SELLA/FOSSA/EAR WO W","code_information":[{"code":"70482","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2624.03,"maximum":4044.97,"gross_charge":4951,"discounted_cash":1133.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2624.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4044.97,"methodology":"fee schedule"}]}]},{"description":"CT ORBIT/SELLA/FOSSA/EAR WO W","code_information":[{"code":"70482","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":4044.97,"gross_charge":4951,"discounted_cash":1133.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":698.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":524.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":524.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2624.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4044.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT MAXILLOFACIAL WO CON","code_information":[{"code":"70486","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":1592.65,"maximum":2455.09,"gross_charge":3005,"discounted_cash":688.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1592.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2455.09,"methodology":"fee schedule"}]}]},{"description":"CT MAXILLOFACIAL WO CON","code_information":[{"code":"70486","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":2455.09,"gross_charge":3005,"discounted_cash":688.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":407.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":305.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":305.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1592.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2455.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT MAXILLOFACIAL W CON","code_information":[{"code":"70487","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2500.01,"maximum":3853.79,"gross_charge":4717,"discounted_cash":1080.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2500.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3853.79,"methodology":"fee schedule"}]}]},{"description":"CT MAXILLOFACIAL W CON","code_information":[{"code":"70487","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":163.79,"maximum":3853.79,"gross_charge":4717,"discounted_cash":1080.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":460.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":345.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":345.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2500.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3853.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT MAXILLOFACIAL WO AND W CON","code_information":[{"code":"70488","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2962.17,"maximum":4566.22,"gross_charge":5589,"discounted_cash":1279.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2962.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4566.22,"methodology":"fee schedule"}]}]},{"description":"CT MAXILLOFACIAL WO AND W CON","code_information":[{"code":"70488","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":4566.22,"gross_charge":5589,"discounted_cash":1279.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":434.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":434.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2962.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4566.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT SOFT TISSUE NECK WO CON","code_information":[{"code":"70490","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":1576.22,"maximum":2429.76,"gross_charge":2974,"discounted_cash":681.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1576.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2429.76,"methodology":"fee schedule"}]}]},{"description":"CT SOFT TISSUE NECK WO CON","code_information":[{"code":"70490","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":2429.76,"gross_charge":2974,"discounted_cash":681.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":418.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":313.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":313.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1576.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2429.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT SOFT TISSUE NECK W CON","code_information":[{"code":"70491","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2159.75,"maximum":3329.28,"gross_charge":4075,"discounted_cash":933.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2159.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3329.28,"methodology":"fee schedule"}]}]},{"description":"CT SOFT TISSUE NECK W CON","code_information":[{"code":"70491","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":3329.28,"gross_charge":4075,"discounted_cash":933.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":554.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":416.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":416.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2159.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3329.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT SOFT TISSUE NECK WO W CON","code_information":[{"code":"70492","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2159.75,"maximum":3329.28,"gross_charge":4075,"discounted_cash":933.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2159.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3329.28,"methodology":"fee schedule"}]}]},{"description":"CT SOFT TISSUE NECK WO W CON","code_information":[{"code":"70492","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":3329.28,"gross_charge":4075,"discounted_cash":933.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":674.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":505.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":505.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2159.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3329.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO HEAD W CON","code_information":[{"code":"70496","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2983.9,"maximum":4599.71,"gross_charge":5630,"discounted_cash":1289.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2983.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4599.71,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO HEAD W CON","code_information":[{"code":"70496","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":4599.71,"gross_charge":5630,"discounted_cash":1289.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":835.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":626.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":626.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2983.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4599.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO NECK W CON","code_information":[{"code":"70498","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":2865.71,"maximum":4417.52,"gross_charge":5407,"discounted_cash":1238.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2865.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4417.52,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO NECK W CON","code_information":[{"code":"70498","type":"CPT"},{"code":"0351","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":4417.52,"gross_charge":5407,"discounted_cash":1238.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":835.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":626.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":626.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2865.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4417.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"MR ORBIT/FACE/NECK WO CON","code_information":[{"code":"70540","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1304.33,"maximum":2010.64,"gross_charge":2461,"discounted_cash":563.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1304.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2010.64,"methodology":"fee schedule"}]}]},{"description":"MR ORBIT/FACE/NECK WO CON","code_information":[{"code":"70540","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":244.25,"maximum":2010.64,"gross_charge":2461,"discounted_cash":563.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":754.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":566.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":566.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1304.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2010.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ORBIT/FACE/NECK W CON","code_information":[{"code":"70542","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1941.92,"maximum":2993.49,"gross_charge":3664,"discounted_cash":839.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1941.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2993.49,"methodology":"fee schedule"}]}]},{"description":"MR ORBIT/FACE/NECK W CON","code_information":[{"code":"70542","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":289.67,"maximum":2993.49,"gross_charge":3664,"discounted_cash":839.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":886.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":665.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":665.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1941.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2993.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ORBIT/FACE/NECK WO W CON","code_information":[{"code":"70543","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2898.04,"maximum":4467.36,"gross_charge":5468,"discounted_cash":1252.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2898.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4467.36,"methodology":"fee schedule"}]}]},{"description":"MR ORBIT/FACE/NECK WO W CON","code_information":[{"code":"70543","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":365.84,"maximum":4467.36,"gross_charge":5468,"discounted_cash":1252.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1102.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":826.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":826.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2898.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4467.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO HEAD WO CON","code_information":[{"code":"70544","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":2178.3,"maximum":3357.87,"gross_charge":4110,"discounted_cash":941.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2178.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3357.87,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO HEAD WO CON","code_information":[{"code":"70544","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":232.45,"maximum":3357.87,"gross_charge":4110,"discounted_cash":941.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":739.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":554.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":554.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2178.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3357.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO HEAD W CON","code_information":[{"code":"70545","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":3680.85,"maximum":5674.07,"gross_charge":6945,"discounted_cash":1590.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3680.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5674.07,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO HEAD W CON","code_information":[{"code":"70545","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":244.97,"maximum":5674.07,"gross_charge":6945,"discounted_cash":1590.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":795.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":596.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":596.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3680.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5674.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO HEAD WO AND W CON","code_information":[{"code":"70546","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":6273.08,"maximum":9670.02,"gross_charge":11836,"discounted_cash":2710.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6273.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9670.02,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO HEAD WO AND W CON","code_information":[{"code":"70546","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":355.83,"maximum":9670.02,"gross_charge":11836,"discounted_cash":2710.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1206.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":905.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":905.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6273.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9670.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO NECK WO CON","code_information":[{"code":"70547","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":1633.99,"maximum":2518.82,"gross_charge":3083,"discounted_cash":706.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1633.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2518.82,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO NECK WO CON","code_information":[{"code":"70547","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":232.81,"maximum":2518.82,"gross_charge":3083,"discounted_cash":706.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":741.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":555.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":555.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1633.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2518.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO NECK W CON","code_information":[{"code":"70548","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":2401.96,"maximum":3702.65,"gross_charge":4532,"discounted_cash":1037.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2401.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3702.65,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO NECK W CON","code_information":[{"code":"70548","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":265.35,"maximum":3702.65,"gross_charge":4532,"discounted_cash":1037.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":816.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":612.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":612.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2401.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3702.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO NECK WO AND W CON","code_information":[{"code":"70549","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":2598.06,"maximum":4004.94,"gross_charge":4902,"discounted_cash":1122.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2598.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4004.94,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO NECK WO AND W CON","code_information":[{"code":"70549","type":"CPT"},{"code":"0615","type":"RC"}],"standard_charges":[{"minimum":372.64,"maximum":4004.94,"gross_charge":4902,"discounted_cash":1122.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1211.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":908.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":908.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2598.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4004.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR BRAIN WO CON","code_information":[{"code":"70551","type":"CPT"},{"code":"0611","type":"RC"}],"standard_charges":[{"minimum":1861.36,"maximum":2869.31,"gross_charge":3512,"discounted_cash":804.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1861.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2869.31,"methodology":"fee schedule"}]}]},{"description":"MR BRAIN WO CON","code_information":[{"code":"70551","type":"CPT"},{"code":"0611","type":"RC"}],"standard_charges":[{"minimum":211.71,"maximum":2869.31,"gross_charge":3512,"discounted_cash":804.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":591.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":443.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":443.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1861.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2869.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR BRAIN W CON","code_information":[{"code":"70552","type":"CPT"},{"code":"0611","type":"RC"}],"standard_charges":[{"minimum":2659.01,"maximum":4098.89,"gross_charge":5017,"discounted_cash":1148.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2659.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4098.89,"methodology":"fee schedule"}]}]},{"description":"MR BRAIN W CON","code_information":[{"code":"70552","type":"CPT"},{"code":"0611","type":"RC"}],"standard_charges":[{"minimum":291.82,"maximum":4098.89,"gross_charge":5017,"discounted_cash":1148.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":868.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":651.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":651.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2659.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4098.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR BRAIN WO AND W CON","code_information":[{"code":"70553","type":"CPT"},{"code":"0611","type":"RC"}],"standard_charges":[{"minimum":3323.63,"maximum":5123.41,"gross_charge":6271,"discounted_cash":1436.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3323.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5123.41,"methodology":"fee schedule"}]}]},{"description":"MR BRAIN WO AND W CON","code_information":[{"code":"70553","type":"CPT"},{"code":"0611","type":"RC"}],"standard_charges":[{"minimum":343.67,"maximum":5123.41,"gross_charge":6271,"discounted_cash":1436.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":735.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":735.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3323.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5123.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES WITH CC/MCC","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"minimum":16280,"maximum":38576.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35126,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35126,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30757.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23068.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23068.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33985.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28026.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38576.03,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16280,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16442.8,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16768.4,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16605.6,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16280,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16280,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16280,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16687,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16280,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"minimum":12737.5,"maximum":33298.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27275,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27275,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33298.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24974.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24974.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26390.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21762.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29954.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12737.5,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12864.88,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13119.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12992.25,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12737.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12737.5,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12737.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13055.94,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12737.5,"methodology":"case rate"}]}]},{"description":"PENIS PROCEDURES WITH CC/MCC","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"minimum":18650.17,"maximum":49627.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45189,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45189,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26801.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20101.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20101.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":43721.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36055.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49627.52,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18650.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18836.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19209.68,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19023.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18650.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18650.17,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18650.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19116.43,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18650.17,"methodology":"case rate"}]}]},{"description":"PENIS PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"minimum":12883.65,"maximum":31683.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28850,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28850,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30837.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23128.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23128.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27913.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23018.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31683.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12883.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13012.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13270.16,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13141.33,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12883.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12883.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12883.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13205.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12883.65,"methodology":"case rate"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE","code_information":[{"code":"7101","type":"APR-DRG"}],"standard_charges":[{"minimum":7015,"maximum":7015,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"}]}]},{"description":"PACU STANDARD 1ST 30MIN","code_information":[{"code":"7101000689","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":837.93,"maximum":1291.68,"gross_charge":1581,"discounted_cash":362.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":837.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1291.68,"methodology":"fee schedule"}]}]},{"description":"PACU STANDARD 1ST 30MIN","code_information":[{"code":"7101000689","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":221.34,"maximum":1291.68,"gross_charge":1581,"discounted_cash":362.05,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":837.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1291.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.34,"methodology":"fee schedule"}]}]},{"description":"PACU STANDARD ADDL 15MIN","code_information":[{"code":"7101000690","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":380.01,"maximum":585.79,"gross_charge":717,"discounted_cash":164.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":380.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":585.79,"methodology":"fee schedule"}]}]},{"description":"PACU STANDARD ADDL 15MIN","code_information":[{"code":"7101000690","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":100.38,"maximum":585.79,"gross_charge":717,"discounted_cash":164.2,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":380.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":585.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.38,"methodology":"fee schedule"}]}]},{"description":"PACU COMPLEX 1ST 30MIN","code_information":[{"code":"7101000691","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":1087.03,"maximum":1675.67,"gross_charge":2051,"discounted_cash":469.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1087.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1675.67,"methodology":"fee schedule"}]}]},{"description":"PACU COMPLEX 1ST 30MIN","code_information":[{"code":"7101000691","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":287.14,"maximum":1675.67,"gross_charge":2051,"discounted_cash":469.68,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1087.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1675.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.14,"methodology":"fee schedule"}]}]},{"description":"PACU COMPLEX ADDL 15MIN","code_information":[{"code":"7101000692","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":127.73,"maximum":196.9,"gross_charge":241,"discounted_cash":55.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.9,"methodology":"fee schedule"}]}]},{"description":"PACU COMPLEX ADDL 15MIN","code_information":[{"code":"7101000692","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":33.74,"maximum":196.9,"gross_charge":241,"discounted_cash":55.19,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.74,"methodology":"fee schedule"}]}]},{"description":"PACU PHII STANDARD 1ST 30MIN","code_information":[{"code":"7101002989","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":619.57,"maximum":955.08,"gross_charge":1169,"discounted_cash":267.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":619.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":955.08,"methodology":"fee schedule"}]}]},{"description":"PACU PHII STANDARD 1ST 30MIN","code_information":[{"code":"7101002989","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":163.66,"maximum":955.08,"gross_charge":1169,"discounted_cash":267.71,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":619.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":955.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.66,"methodology":"fee schedule"}]}]},{"description":"PACU PHII STANDARD ADD 15MIN","code_information":[{"code":"7101002990","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":309.52,"maximum":477.13,"gross_charge":584,"discounted_cash":133.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":309.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.13,"methodology":"fee schedule"}]}]},{"description":"PACU PHII STANDARD ADD 15MIN","code_information":[{"code":"7101002990","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":81.76,"maximum":477.13,"gross_charge":584,"discounted_cash":133.74,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":309.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.76,"methodology":"fee schedule"}]}]},{"description":"PACU PHII COMPLEX ADD 15MIN","code_information":[{"code":"7101002991","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":413.4,"maximum":637.26,"gross_charge":780,"discounted_cash":178.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":413.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":637.26,"methodology":"fee schedule"}]}]},{"description":"PACU PHII COMPLEX ADD 15MIN","code_information":[{"code":"7101002991","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":109.2,"maximum":637.26,"gross_charge":780,"discounted_cash":178.62,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":413.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":637.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE","code_information":[{"code":"7102","type":"APR-DRG"}],"standard_charges":[{"minimum":10123,"maximum":10123,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10123,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10123,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10123,"methodology":"case rate"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE","code_information":[{"code":"7103","type":"APR-DRG"}],"standard_charges":[{"minimum":16511,"maximum":16511,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16511,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16511,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16511,"methodology":"case rate"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE","code_information":[{"code":"7104","type":"APR-DRG"}],"standard_charges":[{"minimum":31814,"maximum":31814,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31814,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31814,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31814,"methodology":"case rate"}]}]},{"description":"XR CHEST 1 VIEW","code_information":[{"code":"71045","type":"CPT"},{"code":"0324","type":"RC"}],"standard_charges":[{"minimum":324.89,"maximum":500.83,"gross_charge":613,"discounted_cash":140.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":324.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.83,"methodology":"fee schedule"}]}]},{"description":"XR CHEST 1 VIEW","code_information":[{"code":"71045","type":"CPT"},{"code":"0324","type":"RC"}],"standard_charges":[{"minimum":26.82,"maximum":500.83,"gross_charge":613,"discounted_cash":140.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":165.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":324.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR CHEST 2 VIEWS","code_information":[{"code":"71046","type":"CPT"},{"code":"0324","type":"RC"}],"standard_charges":[{"minimum":422.41,"maximum":651.15,"gross_charge":797,"discounted_cash":182.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":422.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":651.15,"methodology":"fee schedule"}]}]},{"description":"XR CHEST 2 VIEWS","code_information":[{"code":"71046","type":"CPT"},{"code":"0324","type":"RC"}],"standard_charges":[{"minimum":35.4,"maximum":651.15,"gross_charge":797,"discounted_cash":182.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":223.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":422.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":651.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"TESTES PROCEDURES WITH CC/MCC","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"minimum":14801.25,"maximum":44214.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40260,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40260,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19734.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14801.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14801.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38952.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32122.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44214.21,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16048.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16208.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16529.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16368.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16048.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16048.01,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16048.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16449.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16048.01,"methodology":"case rate"}]}]},{"description":"XR RIBS 2 VIEWS LT","code_information":[{"code":"71100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":289.91,"maximum":446.9,"gross_charge":547,"discounted_cash":125.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":289.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.9,"methodology":"fee schedule"}]}]},{"description":"XR RIBS 2 VIEWS LT","code_information":[{"code":"71100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.62,"maximum":446.9,"gross_charge":547,"discounted_cash":125.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":289.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR RIBS W CHEST 3+ VIEWS LT","code_information":[{"code":"71101","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":473.82,"maximum":730.4,"gross_charge":894,"discounted_cash":204.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":473.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":730.4,"methodology":"fee schedule"}]}]},{"description":"XR RIBS W CHEST 3+ VIEWS LT","code_information":[{"code":"71101","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":44.34,"maximum":730.4,"gross_charge":894,"discounted_cash":204.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":473.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":730.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"POST-OPERATIVE POST-TRAUMA OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE","code_information":[{"code":"7111","type":"APR-DRG"}],"standard_charges":[{"minimum":6800,"maximum":6800,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6800,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6800,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6800,"methodology":"case rate"}]}]},{"description":"XR RIBS W CHEST 4+ VIEWS BIL","code_information":[{"code":"71111","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":707.55,"maximum":1090.7,"gross_charge":1335,"discounted_cash":305.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":707.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1090.7,"methodology":"fee schedule"}]}]},{"description":"XR RIBS W CHEST 4+ VIEWS BIL","code_information":[{"code":"71111","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":55.07,"maximum":1090.7,"gross_charge":1335,"discounted_cash":305.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":363.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":363.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":707.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1090.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"POST-OPERATIVE POST-TRAUMA OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE","code_information":[{"code":"7112","type":"APR-DRG"}],"standard_charges":[{"minimum":9102,"maximum":9102,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9102,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9102,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9102,"methodology":"case rate"}]}]},{"description":"XR STERNUM 2+ VIEWS","code_information":[{"code":"71120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":289.91,"maximum":446.9,"gross_charge":547,"discounted_cash":125.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":289.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.9,"methodology":"fee schedule"}]}]},{"description":"XR STERNUM 2+ VIEWS","code_information":[{"code":"71120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.4,"maximum":446.9,"gross_charge":547,"discounted_cash":125.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":289.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"POST-OPERATIVE POST-TRAUMA OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE","code_information":[{"code":"7113","type":"APR-DRG"}],"standard_charges":[{"minimum":15919,"maximum":15919,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15919,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15919,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15919,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMA OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE","code_information":[{"code":"7114","type":"APR-DRG"}],"standard_charges":[{"minimum":31488,"maximum":31488,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31488,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31488,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31488,"methodology":"case rate"}]}]},{"description":"TESTES PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"minimum":9544.54,"maximum":21908.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19164,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19164,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21908.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16431.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16431.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18542.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15290.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21046.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9544.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9639.99,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9830.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9735.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9544.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9544.54,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9544.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9783.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9544.54,"methodology":"case rate"}]}]},{"description":"CT CHEST WO CON","code_information":[{"code":"71250","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1579.93,"maximum":2435.48,"gross_charge":2981,"discounted_cash":682.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1579.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2435.48,"methodology":"fee schedule"}]}]},{"description":"CT CHEST WO CON","code_information":[{"code":"71250","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":2435.48,"gross_charge":2981,"discounted_cash":682.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":287.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":287.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1579.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2435.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT CHEST W CON","code_information":[{"code":"71260","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2543.47,"maximum":3920.79,"gross_charge":4799,"discounted_cash":1098.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2543.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3920.79,"methodology":"fee schedule"}]}]},{"description":"CT CHEST W CON","code_information":[{"code":"71260","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":179.88,"maximum":3920.79,"gross_charge":4799,"discounted_cash":1098.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":391.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":391.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2543.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3920.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT CHEST WO AND W CON","code_information":[{"code":"71270","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":3064.99,"maximum":4724.72,"gross_charge":5783,"discounted_cash":1324.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3064.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4724.72,"methodology":"fee schedule"}]}]},{"description":"CT CHEST WO AND W CON","code_information":[{"code":"71270","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":4724.72,"gross_charge":5783,"discounted_cash":1324.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":638.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":478.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":478.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3064.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4724.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT LUNG SCREENING LOW DOSE","code_information":[{"code":"71271","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":94.87,"maximum":146.25,"gross_charge":179,"discounted_cash":41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"}]}]},{"description":"CT LUNG SCREENING LOW DOSE","code_information":[{"code":"71271","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":94.87,"maximum":1482,"gross_charge":179,"discounted_cash":41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":404.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":303.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":303.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO CHEST W CON","code_information":[{"code":"71275","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2589.58,"maximum":3991.87,"gross_charge":4886,"discounted_cash":1118.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2589.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3991.87,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO CHEST W CON","code_information":[{"code":"71275","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":3991.87,"gross_charge":4886,"discounted_cash":1118.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":835.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":626.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":626.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2589.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3991.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY WITH CC/MCC","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"minimum":11193.09,"maximum":30161.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27463,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27463,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14923.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11193.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11193.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26571.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21912.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30161.06,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12455.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12579.81,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12828.91,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12704.36,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12455.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12455.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12455.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12766.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12455.25,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"minimum":8540.02,"maximum":32502.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17195,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17195,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32502.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24377.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24377.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16637.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13720.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18884.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8540.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8625.43,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8796.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8710.83,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8540.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8540.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8540.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8753.53,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8540.02,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"minimum":18020.04,"maximum":44075.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40134,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40134,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24026.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18020.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18020.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38830.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32021.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44075.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18736.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18924.15,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19298.89,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19111.52,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18736.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18736.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18736.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19205.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18736.78,"methodology":"case rate"}]}]},{"description":"MR CHEST WO CON","code_information":[{"code":"71550","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1247.09,"maximum":1922.41,"gross_charge":2353,"discounted_cash":538.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1247.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1922.41,"methodology":"fee schedule"}]}]},{"description":"MR CHEST WO CON","code_information":[{"code":"71550","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":257.63,"maximum":1922.41,"gross_charge":2353,"discounted_cash":538.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1133.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":850.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":850.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1247.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1922.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR CHEST W CON","code_information":[{"code":"71551","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1870.9,"maximum":2884.01,"gross_charge":3530,"discounted_cash":808.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1870.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2884.01,"methodology":"fee schedule"}]}]},{"description":"MR CHEST W CON","code_information":[{"code":"71551","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":403.03,"maximum":2884.01,"gross_charge":3530,"discounted_cash":808.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1352.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1014.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1014.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1870.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2884.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"MR CHEST WO AND W CON","code_information":[{"code":"71552","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1870.9,"maximum":2884.01,"gross_charge":3530,"discounted_cash":808.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1870.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2884.01,"methodology":"fee schedule"}]}]},{"description":"MR CHEST WO AND W CON","code_information":[{"code":"71552","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":380.64,"maximum":2884.01,"gross_charge":3530,"discounted_cash":808.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1673.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1255.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1255.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1870.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2884.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"minimum":12248.77,"maximum":31841.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27529,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27529,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31841.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23881.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23881.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26635.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21964.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30233.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12248.77,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12371.26,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12616.24,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12493.75,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12248.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12248.77,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12248.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12554.99,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12248.77,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"minimum":15621.92,"maximum":36397.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33142,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33142,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21011.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15759.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15759.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32066.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26443.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36397.5,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15621.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15778.14,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16090.58,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15934.36,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15621.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15621.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15621.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16012.47,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15621.92,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"minimum":10799.61,"maximum":25156.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22906,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22906,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23323.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17493.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17493.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22162.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18276.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25156.22,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10799.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10907.61,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11123.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11015.61,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10799.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10799.61,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10799.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11069.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10799.61,"methodology":"case rate"}]}]},{"description":"LABOR ROOM/DELIVERY - GENERAL","code_information":[{"code":"720","type":"RC"}],"standard_charges":[{"minimum":1334.7,"maximum":2022,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1779.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1334.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1334.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1485,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2022,"methodology":"case rate"}]}]},{"description":"SEPTICEMIA AND DISSEMINATED INFECTIONS","code_information":[{"code":"7201","type":"APR-DRG"}],"standard_charges":[{"minimum":3682,"maximum":3682,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3682,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3682,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3682,"methodology":"case rate"}]}]},{"description":"SEPTICEMIA AND DISSEMINATED INFECTIONS","code_information":[{"code":"7202","type":"APR-DRG"}],"standard_charges":[{"minimum":4722,"maximum":4722,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4722,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4722,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4722,"methodology":"case rate"}]}]},{"description":"XR CERVICAL SPINE 1 VIEW","code_information":[{"code":"72020","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":246.98,"maximum":380.73,"gross_charge":466,"discounted_cash":106.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":246.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":380.73,"methodology":"fee schedule"}]}]},{"description":"XR CERVICAL SPINE 1 VIEW","code_information":[{"code":"72020","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":25.39,"maximum":380.73,"gross_charge":466,"discounted_cash":106.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":246.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":380.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"SEPTICEMIA AND DISSEMINATED INFECTIONS","code_information":[{"code":"7203","type":"APR-DRG"}],"standard_charges":[{"minimum":7198,"maximum":7198,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7198,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7198,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7198,"methodology":"case rate"}]}]},{"description":"SEPTICEMIA AND DISSEMINATED INFECTIONS","code_information":[{"code":"7204","type":"APR-DRG"}],"standard_charges":[{"minimum":14081,"maximum":14081,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14081,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14081,"methodology":"case rate"}]}]},{"description":"XR CERVICAL SPINE 2-3 VIEWS","code_information":[{"code":"72040","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":531.59,"maximum":819.46,"gross_charge":1003,"discounted_cash":229.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":531.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":819.46,"methodology":"fee schedule"}]}]},{"description":"XR CERVICAL SPINE 2-3 VIEWS","code_information":[{"code":"72040","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.48,"maximum":819.46,"gross_charge":1003,"discounted_cash":229.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":279.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":531.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":819.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR CERVICAL SPINE 4-5 VIEWS","code_information":[{"code":"72050","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":642.89,"maximum":991.03,"gross_charge":1213,"discounted_cash":277.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":642.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":991.03,"methodology":"fee schedule"}]}]},{"description":"XR CERVICAL SPINE 4-5 VIEWS","code_information":[{"code":"72050","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":56.15,"maximum":991.03,"gross_charge":1213,"discounted_cash":277.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":389.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":105.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":105.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":642.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":991.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR CERVICAL SPINE >=6 VIEWS","code_information":[{"code":"72052","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1004.35,"maximum":1548.22,"gross_charge":1895,"discounted_cash":433.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1004.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1548.22,"methodology":"fee schedule"}]}]},{"description":"XR CERVICAL SPINE >=6 VIEWS","code_information":[{"code":"72052","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":65.8,"maximum":1548.22,"gross_charge":1895,"discounted_cash":433.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":464.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":122.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":122.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1004.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1548.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR THORACIC SPINE 3 VIEWS","code_information":[{"code":"72072","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":500.32,"maximum":771.25,"gross_charge":944,"discounted_cash":216.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":500.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":771.25,"methodology":"fee schedule"}]}]},{"description":"XR THORACIC SPINE 3 VIEWS","code_information":[{"code":"72072","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.48,"maximum":771.25,"gross_charge":944,"discounted_cash":216.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":275.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":73.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":73.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":500.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":771.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR THORACOLUM JUNCT >=2 VIEWS","code_information":[{"code":"72080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":304.75,"maximum":469.78,"gross_charge":575,"discounted_cash":131.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":304.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":469.78,"methodology":"fee schedule"}]}]},{"description":"XR THORACOLUM JUNCT >=2 VIEWS","code_information":[{"code":"72080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.48,"maximum":469.78,"gross_charge":575,"discounted_cash":131.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":63.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":63.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":304.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":469.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR SPINE ENTIRE 6+ VIEWS","code_information":[{"code":"72084","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":816.2,"maximum":1258.18,"gross_charge":1540,"discounted_cash":352.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":816.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1258.18,"methodology":"fee schedule"}]}]},{"description":"XR SPINE ENTIRE 6+ VIEWS","code_information":[{"code":"72084","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":103.35,"maximum":1258.18,"gross_charge":1540,"discounted_cash":352.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":763.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":763.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":200.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":200.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":816.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1258.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"LABOR ROOM/DELIVERY - LABOR","code_information":[{"code":"721","type":"RC"}],"standard_charges":[{"minimum":1334.7,"maximum":2022,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1779.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1334.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1334.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1485,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2022,"methodology":"case rate"}]}]},{"description":"XR LUMBAR SPINE 2 OR 3 VIEWS","code_information":[{"code":"72100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":756.31,"maximum":1165.86,"gross_charge":1427,"discounted_cash":326.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":756.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1165.86,"methodology":"fee schedule"}]}]},{"description":"XR LUMBAR SPINE 2 OR 3 VIEWS","code_information":[{"code":"72100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.84,"maximum":1165.86,"gross_charge":1427,"discounted_cash":326.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":282.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":756.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1165.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"POST-OPERATIVE POST-TRAUMATIC OTHER DEVICE INFECTIONS","code_information":[{"code":"7211","type":"APR-DRG"}],"standard_charges":[{"minimum":3821,"maximum":3821,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3821,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3821,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3821,"methodology":"case rate"}]}]},{"description":"XR LUMBAR SPINE 4+ VIEWS","code_information":[{"code":"72110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":771.15,"maximum":1188.74,"gross_charge":1455,"discounted_cash":333.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":771.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1188.74,"methodology":"fee schedule"}]}]},{"description":"XR LUMBAR SPINE 4+ VIEWS","code_information":[{"code":"72110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":54.72,"maximum":1188.74,"gross_charge":1455,"discounted_cash":333.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":100.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":100.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":771.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1188.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR L SPINE COMP W BEND 6+VIEWS","code_information":[{"code":"72114","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":733.52,"maximum":1130.73,"gross_charge":1384,"discounted_cash":316.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":733.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1130.73,"methodology":"fee schedule"}]}]},{"description":"XR L SPINE COMP W BEND 6+VIEWS","code_information":[{"code":"72114","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":64.37,"maximum":1130.73,"gross_charge":1384,"discounted_cash":316.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":461.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":119.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":119.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":733.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1130.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"POST-OPERATIVE POST-TRAUMATIC OTHER DEVICE INFECTIONS","code_information":[{"code":"7212","type":"APR-DRG"}],"standard_charges":[{"minimum":5027,"maximum":5027,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5027,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5027,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5027,"methodology":"case rate"}]}]},{"description":"XR L SPINE BEND ONLY 2-3 VIEWS","code_information":[{"code":"72120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":854.36,"maximum":1317.01,"gross_charge":1612,"discounted_cash":369.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":854.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1317.01,"methodology":"fee schedule"}]}]},{"description":"XR L SPINE BEND ONLY 2-3 VIEWS","code_information":[{"code":"72120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.56,"maximum":1317.01,"gross_charge":1612,"discounted_cash":369.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":292.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":854.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1317.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT CERVICAL SPINE WO CON","code_information":[{"code":"72125","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2395.6,"maximum":3692.84,"gross_charge":4520,"discounted_cash":1035.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2395.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3692.84,"methodology":"fee schedule"}]}]},{"description":"CT CERVICAL SPINE WO CON","code_information":[{"code":"72125","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":3692.84,"gross_charge":4520,"discounted_cash":1035.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":388.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":291.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":291.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2395.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3692.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT CERVICAL SPINE W CON","code_information":[{"code":"72126","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2731.09,"maximum":4210.01,"gross_charge":5153,"discounted_cash":1180.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2731.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4210.01,"methodology":"fee schedule"}]}]},{"description":"CT CERVICAL SPINE W CON","code_information":[{"code":"72126","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":181.67,"maximum":4210.01,"gross_charge":5153,"discounted_cash":1180.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":518.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":388.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":388.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2731.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4210.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"CT CERVICAL SPINE WO AND W CON","code_information":[{"code":"72127","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":3809.11,"maximum":5871.78,"gross_charge":7187,"discounted_cash":1645.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3809.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5871.78,"methodology":"fee schedule"}]}]},{"description":"CT CERVICAL SPINE WO AND W CON","code_information":[{"code":"72127","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":5871.78,"gross_charge":7187,"discounted_cash":1645.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":636.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":477.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":477.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3809.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5871.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT THORACIC SPINE WO CON","code_information":[{"code":"72128","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2395.6,"maximum":3692.84,"gross_charge":4520,"discounted_cash":1035.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2395.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3692.84,"methodology":"fee schedule"}]}]},{"description":"CT THORACIC SPINE WO CON","code_information":[{"code":"72128","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":3692.84,"gross_charge":4520,"discounted_cash":1035.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2395.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3692.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT THORACIC SPINE W CON","code_information":[{"code":"72129","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2731.09,"maximum":4210.01,"gross_charge":5153,"discounted_cash":1180.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2731.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4210.01,"methodology":"fee schedule"}]}]},{"description":"CT THORACIC SPINE W CON","code_information":[{"code":"72129","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":183.1,"maximum":4210.01,"gross_charge":5153,"discounted_cash":1180.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":524.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":393.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":393.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2731.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4210.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"POST-OPERATIVE POST-TRAUMATIC OTHER DEVICE INFECTIONS","code_information":[{"code":"7213","type":"APR-DRG"}],"standard_charges":[{"minimum":8169,"maximum":8169,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8169,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8169,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8169,"methodology":"case rate"}]}]},{"description":"CT THORACIC SPINE WO W CON","code_information":[{"code":"72130","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":3809.11,"maximum":5871.78,"gross_charge":7187,"discounted_cash":1645.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3809.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5871.78,"methodology":"fee schedule"}]}]},{"description":"CT THORACIC SPINE WO W CON","code_information":[{"code":"72130","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":5871.78,"gross_charge":7187,"discounted_cash":1645.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":645.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":484.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":484.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3809.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5871.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT LUMBAR SPINE WO CON","code_information":[{"code":"72131","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2395.6,"maximum":3692.84,"gross_charge":4520,"discounted_cash":1035.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2395.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3692.84,"methodology":"fee schedule"}]}]},{"description":"CT LUMBAR SPINE WO CON","code_information":[{"code":"72131","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":3692.84,"gross_charge":4520,"discounted_cash":1035.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":385.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":288.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":288.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2395.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3692.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT LUMBAR SPINE W CON","code_information":[{"code":"72132","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2731.09,"maximum":4210.01,"gross_charge":5153,"discounted_cash":1180.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2731.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4210.01,"methodology":"fee schedule"}]}]},{"description":"CT LUMBAR SPINE W CON","code_information":[{"code":"72132","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":182.03,"maximum":4210.01,"gross_charge":5153,"discounted_cash":1180.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":391.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":391.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2731.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4210.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"CT LUMBAR SPINE WO AND W CON","code_information":[{"code":"72133","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":3809.11,"maximum":5871.78,"gross_charge":7187,"discounted_cash":1645.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3809.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5871.78,"methodology":"fee schedule"}]}]},{"description":"CT LUMBAR SPINE WO AND W CON","code_information":[{"code":"72133","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":5871.78,"gross_charge":7187,"discounted_cash":1645.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":638.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":478.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":478.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3809.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5871.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"POST-OPERATIVE POST-TRAUMATIC OTHER DEVICE INFECTIONS","code_information":[{"code":"7214","type":"APR-DRG"}],"standard_charges":[{"minimum":14852,"maximum":14852,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14852,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14852,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14852,"methodology":"case rate"}]}]},{"description":"MR CERVICAL SPINE WO CON LTD","code_information":[{"code":"72141","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":1711.9,"maximum":2638.91,"gross_charge":3230,"discounted_cash":739.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1711.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2638.91,"methodology":"fee schedule"}]}]},{"description":"MR CERVICAL SPINE WO CON LTD","code_information":[{"code":"72141","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":205.99,"maximum":2638.91,"gross_charge":3230,"discounted_cash":739.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":421.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":421.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1711.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2638.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR CERVICAL SPINE W CON","code_information":[{"code":"72142","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":2419.98,"maximum":3730.43,"gross_charge":4566,"discounted_cash":1045.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2419.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3730.43,"methodology":"fee schedule"}]}]},{"description":"MR CERVICAL SPINE W CON","code_information":[{"code":"72142","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":297.54,"maximum":3730.43,"gross_charge":4566,"discounted_cash":1045.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":885.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":663.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":663.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2419.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3730.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR THORACIC SPINE WO CON","code_information":[{"code":"72146","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":1987.5,"maximum":3063.75,"gross_charge":3750,"discounted_cash":858.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1987.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3063.75,"methodology":"fee schedule"}]}]},{"description":"MR THORACIC SPINE WO CON","code_information":[{"code":"72146","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":205.63,"maximum":3063.75,"gross_charge":3750,"discounted_cash":858.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":563.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":422.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":422.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1987.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3063.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR THORACIC SPINE W CON","code_information":[{"code":"72147","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":3115.87,"maximum":4803.15,"gross_charge":5879,"discounted_cash":1346.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3115.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4803.15,"methodology":"fee schedule"}]}]},{"description":"MR THORACIC SPINE W CON","code_information":[{"code":"72147","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":294.68,"maximum":4803.15,"gross_charge":5879,"discounted_cash":1346.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":876.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":657.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":657.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3115.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4803.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR LUMBAR SPINE WO CON LTD","code_information":[{"code":"72148","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":1772.85,"maximum":2732.87,"gross_charge":3345,"discounted_cash":766.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1772.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2732.87,"methodology":"fee schedule"}]}]},{"description":"MR LUMBAR SPINE WO CON LTD","code_information":[{"code":"72148","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":206.7,"maximum":2732.87,"gross_charge":3345,"discounted_cash":766.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":424.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":424.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1772.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2732.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR LUMBAR SPINE W CON","code_information":[{"code":"72149","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":2417.33,"maximum":3726.34,"gross_charge":4561,"discounted_cash":1044.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2417.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3726.34,"methodology":"fee schedule"}]}]},{"description":"MR LUMBAR SPINE W CON","code_information":[{"code":"72149","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":292.17,"maximum":3726.34,"gross_charge":4561,"discounted_cash":1044.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":863.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":648.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":648.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2417.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3726.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR CERVICAL SPINE WO AND W CON","code_information":[{"code":"72156","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":5902.08,"maximum":9098.12,"gross_charge":11136,"discounted_cash":2550.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5902.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9098.12,"methodology":"fee schedule"}]}]},{"description":"MR CERVICAL SPINE WO AND W CON","code_information":[{"code":"72156","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":345.46,"maximum":9098.12,"gross_charge":11136,"discounted_cash":2550.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":983.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":737.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":737.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5902.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9098.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR THORACIC SPINE WO AND W CON","code_information":[{"code":"72157","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":5372.08,"maximum":8281.12,"gross_charge":10136,"discounted_cash":2321.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5372.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8281.12,"methodology":"fee schedule"}]}]},{"description":"MR THORACIC SPINE WO AND W CON","code_information":[{"code":"72157","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":346.17,"maximum":8281.12,"gross_charge":10136,"discounted_cash":2321.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":986.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":740.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":740.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5372.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8281.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR LUMBAR SPINE WO AND W CON","code_information":[{"code":"72158","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":5372.08,"maximum":8281.12,"gross_charge":10136,"discounted_cash":2321.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5372.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8281.12,"methodology":"fee schedule"}]}]},{"description":"MR LUMBAR SPINE WO AND W CON","code_information":[{"code":"72158","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":344.74,"maximum":8281.12,"gross_charge":10136,"discounted_cash":2321.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":735.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":735.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5372.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8281.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR PELVIS 1 OR 2 VIEWS","code_information":[{"code":"72170","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":330.19,"maximum":509,"gross_charge":623,"discounted_cash":142.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":330.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":509,"methodology":"fee schedule"}]}]},{"description":"XR PELVIS 1 OR 2 VIEWS","code_information":[{"code":"72170","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":29.32,"maximum":509,"gross_charge":623,"discounted_cash":142.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":330.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":509,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO PELVIS W CON","code_information":[{"code":"72191","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1459.62,"maximum":2250.02,"gross_charge":2754,"discounted_cash":630.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1459.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2250.02,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO PELVIS W CON","code_information":[{"code":"72191","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":2250.02,"gross_charge":2754,"discounted_cash":630.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1459.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2250.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT PELVIS WO CON","code_information":[{"code":"72192","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2546.12,"maximum":3924.87,"gross_charge":4804,"discounted_cash":1100.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2546.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3924.87,"methodology":"fee schedule"}]}]},{"description":"CT PELVIS WO CON","code_information":[{"code":"72192","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":3924.87,"gross_charge":4804,"discounted_cash":1100.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":286.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":286.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2546.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3924.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT PELVIS W CON","code_information":[{"code":"72193","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2876.84,"maximum":4434.68,"gross_charge":5428,"discounted_cash":1243.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2876.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4434.68,"methodology":"fee schedule"}]}]},{"description":"CT PELVIS W CON","code_information":[{"code":"72193","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":4434.68,"gross_charge":5428,"discounted_cash":1243.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":798.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":599.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":599.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2876.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4434.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT PELVIS WO AND W CON","code_information":[{"code":"72194","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":3233.53,"maximum":4984.52,"gross_charge":6101,"discounted_cash":1397.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3233.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4984.52,"methodology":"fee schedule"}]}]},{"description":"CT PELVIS WO AND W CON","code_information":[{"code":"72194","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":4984.52,"gross_charge":6101,"discounted_cash":1397.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3233.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4984.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"MR PELVIS WO CON","code_information":[{"code":"72195","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2136.43,"maximum":3293.33,"gross_charge":4031,"discounted_cash":923.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2136.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3293.33,"methodology":"fee schedule"}]}]},{"description":"MR PELVIS WO CON","code_information":[{"code":"72195","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":247.47,"maximum":3293.33,"gross_charge":4031,"discounted_cash":923.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":739.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":554.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":554.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2136.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3293.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR PELVIS W CON","code_information":[{"code":"72196","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":3343.77,"maximum":5154.46,"gross_charge":6309,"discounted_cash":1444.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3343.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5154.46,"methodology":"fee schedule"}]}]},{"description":"MR PELVIS W CON","code_information":[{"code":"72196","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":289.67,"maximum":5154.46,"gross_charge":6309,"discounted_cash":1444.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":869.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":652.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":652.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3343.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5154.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR PELVIS WO AND W CON","code_information":[{"code":"72197","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":4360.31,"maximum":6721.46,"gross_charge":8227,"discounted_cash":1883.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4360.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6721.46,"methodology":"fee schedule"}]}]},{"description":"MR PELVIS WO AND W CON","code_information":[{"code":"72197","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":363.7,"maximum":6721.46,"gross_charge":8227,"discounted_cash":1883.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1080.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":810.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":810.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4360.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6721.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"LABOR ROOM/DELIVERY - DELIVERY","code_information":[{"code":"722","type":"RC"}],"standard_charges":[{"minimum":1334.7,"maximum":2022,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1779.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1334.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1334.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1485,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2022,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM WITH MCC","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"minimum":14642.92,"maximum":37235.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33905,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33905,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22489.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16867.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16867.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32804.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27051.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37235.08,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14642.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14789.35,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15082.21,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14935.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14642.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14642.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14642.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15009,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14642.92,"methodology":"case rate"}]}]},{"description":"XR SACROILIAC JOINTS <3 VIEWS","code_information":[{"code":"72200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":184.97,"maximum":285.14,"gross_charge":349,"discounted_cash":79.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":184.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.14,"methodology":"fee schedule"}]}]},{"description":"XR SACROILIAC JOINTS <3 VIEWS","code_information":[{"code":"72200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.05,"maximum":383.01,"gross_charge":349,"discounted_cash":79.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":64.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":64.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":184.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR SACROILIAC JOINTS 3+ VIEWS","code_information":[{"code":"72202","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":257.58,"maximum":397.07,"gross_charge":486,"discounted_cash":111.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":257.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":397.07,"methodology":"fee schedule"}]}]},{"description":"XR SACROILIAC JOINTS 3+ VIEWS","code_information":[{"code":"72202","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.13,"maximum":397.07,"gross_charge":486,"discounted_cash":111.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":275.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":73.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":73.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":257.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":397.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"7221","type":"APR-DRG"}],"standard_charges":[{"minimum":2635,"maximum":2635,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2635,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2635,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2635,"methodology":"case rate"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"7222","type":"APR-DRG"}],"standard_charges":[{"minimum":3758,"maximum":3758,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"}]}]},{"description":"XR SACRUM AND COCCYX 2+ VIEWS","code_information":[{"code":"72220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":318.53,"maximum":491.02,"gross_charge":601,"discounted_cash":137.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":318.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":491.02,"methodology":"fee schedule"}]}]},{"description":"XR SACRUM AND COCCYX 2+ VIEWS","code_information":[{"code":"72220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.33,"maximum":491.02,"gross_charge":601,"discounted_cash":137.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":318.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":491.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"7223","type":"APR-DRG"}],"standard_charges":[{"minimum":5083,"maximum":5083,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5083,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5083,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5083,"methodology":"case rate"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"7224","type":"APR-DRG"}],"standard_charges":[{"minimum":8539,"maximum":8539,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8539,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8539,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8539,"methodology":"case rate"}]}]},{"description":"XR MYELOGRAM CERVICAL SPINE","code_information":[{"code":"72240","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2328.82,"maximum":3589.9,"gross_charge":4394,"discounted_cash":1006.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3589.9,"methodology":"fee schedule"}]}]},{"description":"XR MYELOGRAM CERVICAL SPINE","code_information":[{"code":"72240","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":117.66,"maximum":3589.9,"gross_charge":4394,"discounted_cash":1006.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":701.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":701.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":174.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":174.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2654.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2654.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3589.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"XR MYELOGRAM THORACIC SPINE","code_information":[{"code":"72255","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2328.82,"maximum":3589.9,"gross_charge":4394,"discounted_cash":1006.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3589.9,"methodology":"fee schedule"}]}]},{"description":"XR MYELOGRAM THORACIC SPINE","code_information":[{"code":"72255","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":113.01,"maximum":3589.9,"gross_charge":4394,"discounted_cash":1006.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":714.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":714.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2654.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2654.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3589.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"XR MYELOGRAM LUMBAR SPINE","code_information":[{"code":"72265","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2328.82,"maximum":3589.9,"gross_charge":4394,"discounted_cash":1006.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3589.9,"methodology":"fee schedule"}]}]},{"description":"XR MYELOGRAM LUMBAR SPINE","code_information":[{"code":"72265","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":114.44,"maximum":3589.9,"gross_charge":4394,"discounted_cash":1006.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":685.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":685.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":175.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":175.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2654.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2654.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3589.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"XR MYELOGRAM 2 OR > REGIONS SP","code_information":[{"code":"72270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2328.82,"maximum":3589.9,"gross_charge":4394,"discounted_cash":1006.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3589.9,"methodology":"fee schedule"}]}]},{"description":"XR MYELOGRAM 2 OR > REGIONS SP","code_information":[{"code":"72270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":160.57,"maximum":3589.9,"gross_charge":4394,"discounted_cash":1006.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":987.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":987.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":295.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":221.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":221.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2654.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2654.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3589.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"LABOR ROOM/DELIVERY - CIRCUMSICION","code_information":[{"code":"723","type":"RC"}],"standard_charges":[{"minimum":1334.7,"maximum":1779.3,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1779.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1334.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1334.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM WITH CC","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"minimum":9890,"maximum":22845.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20802,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20802,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13186.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9890,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9890,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20126.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16597.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22845.66,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9956.71,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10056.28,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10255.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10155.85,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9956.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9956.71,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9956.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10205.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9956.71,"methodology":"case rate"}]}]},{"description":"VIRAL ILLNESS","code_information":[{"code":"7231","type":"APR-DRG"}],"standard_charges":[{"minimum":2467,"maximum":2467,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2467,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2467,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2467,"methodology":"case rate"}]}]},{"description":"VIRAL ILLNESS","code_information":[{"code":"7232","type":"APR-DRG"}],"standard_charges":[{"minimum":3498,"maximum":3498,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3498,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3498,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3498,"methodology":"case rate"}]}]},{"description":"VIRAL ILLNESS","code_information":[{"code":"7233","type":"APR-DRG"}],"standard_charges":[{"minimum":5641,"maximum":5641,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5641,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5641,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5641,"methodology":"case rate"}]}]},{"description":"VIRAL ILLNESS","code_information":[{"code":"7234","type":"APR-DRG"}],"standard_charges":[{"minimum":12984,"maximum":12984,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12984,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12984,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12984,"methodology":"case rate"}]}]},{"description":"LABOR ROOM/DELIVERY - BIRTHING CENTER","code_information":[{"code":"724","type":"RC"}],"standard_charges":[{"minimum":1485,"maximum":6097.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4573.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1485,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2022,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"minimum":6907.58,"maximum":18938.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11090,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11090,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18938.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14204.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14204.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10730.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8848.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12179.95,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6907.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6976.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7114.81,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7045.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6907.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6907.58,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6907.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7080.27,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6907.58,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES","code_information":[{"code":"7241","type":"APR-DRG"}],"standard_charges":[{"minimum":3704,"maximum":3704,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3704,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3704,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3704,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES","code_information":[{"code":"7242","type":"APR-DRG"}],"standard_charges":[{"minimum":4482,"maximum":4482,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4482,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4482,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4482,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES","code_information":[{"code":"7243","type":"APR-DRG"}],"standard_charges":[{"minimum":7740,"maximum":7740,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7740,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7740,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7740,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES","code_information":[{"code":"7244","type":"APR-DRG"}],"standard_charges":[{"minimum":17651,"maximum":17651,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17651,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17651,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17651,"methodology":"case rate"}]}]},{"description":"BENIGN PROSTATIC HYPERTROPHY WITH MCC","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"minimum":9812.12,"maximum":25898.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23582,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23582,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13082.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9812.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9812.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22816.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18815.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25898.9,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11037.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11147.39,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11368.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11257.76,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11037.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11037.01,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11037.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11312.94,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11037.01,"methodology":"case rate"}]}]},{"description":"BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"minimum":7029.76,"maximum":25500.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14364,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14364,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25500.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19125.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19125.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13898.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11461.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15775.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7029.76,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7100.06,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7240.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7170.36,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7029.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7029.76,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7029.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7205.51,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7029.76,"methodology":"case rate"}]}]},{"description":"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"minimum":12636.2,"maximum":29445.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26811,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26811,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18312.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13734.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13734.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25941.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21392.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29445.19,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12762.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13015.29,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12888.93,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12952.11,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12636.2,"methodology":"case rate"}]}]},{"description":"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"minimum":7591.95,"maximum":23358.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15074,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15074,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23358.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17519.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17519.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14585.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12027.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16555.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7591.95,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7667.87,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7819.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7743.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7591.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7591.95,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7591.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7781.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7591.95,"methodology":"case rate"}]}]},{"description":"LABOR ROOM/DELIVERY - OTHER LABOR ROOM/DELIVERY","code_information":[{"code":"729","type":"RC"}],"standard_charges":[{"minimum":1483,"maximum":2022,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1977,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1483,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1483,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1485,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2022,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"minimum":9786.58,"maximum":22154.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20173,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20173,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17280.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12960.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12960.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19518.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16095.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22154.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9786.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9884.45,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10080.18,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9982.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9786.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9786.58,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9786.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10031.25,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9786.58,"methodology":"case rate"}]}]},{"description":"EKG/ECG","code_information":[{"code":"730","type":"RC"}],"standard_charges":[{"minimum":297,"maximum":360,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":351,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":297,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":360,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"minimum":5966.47,"maximum":41348.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11864,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11864,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41348.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31012.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31012.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11479.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9466.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13029.9,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5966.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6026.14,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6145.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6085.8,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5966.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5966.47,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5966.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6115.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5966.47,"methodology":"case rate"}]}]},{"description":"XR CLAVICLE COMPLETE BIL","code_information":[{"code":"73000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":675.75,"maximum":1041.68,"gross_charge":1275,"discounted_cash":291.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":675.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1041.68,"methodology":"fee schedule"}]}]},{"description":"XR CLAVICLE COMPLETE BIL","code_information":[{"code":"73000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.33,"maximum":1041.68,"gross_charge":1275,"discounted_cash":291.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":63.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":63.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":675.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1041.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR CLAVICLE COMPLETE RT","code_information":[{"code":"73000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":451.03,"maximum":695.27,"gross_charge":851,"discounted_cash":194.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":451.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":695.27,"methodology":"fee schedule"}]}]},{"description":"XR CLAVICLE COMPLETE RT","code_information":[{"code":"73000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.33,"maximum":695.27,"gross_charge":851,"discounted_cash":194.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":63.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":63.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":451.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":695.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR SCAPULA COMPLETE RT","code_information":[{"code":"73010","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":427.71,"maximum":659.32,"gross_charge":807,"discounted_cash":184.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":427.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":659.32,"methodology":"fee schedule"}]}]},{"description":"XR SCAPULA COMPLETE RT","code_information":[{"code":"73010","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":25.03,"maximum":659.32,"gross_charge":807,"discounted_cash":184.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":427.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":659.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR SHOULDER 1 VIEW RT","code_information":[{"code":"73020","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":340.26,"maximum":524.52,"gross_charge":642,"discounted_cash":147.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":340.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":524.52,"methodology":"fee schedule"}]}]},{"description":"XR SHOULDER 1 VIEW RT","code_information":[{"code":"73020","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":22.89,"maximum":524.52,"gross_charge":642,"discounted_cash":147.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":340.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":524.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR SHOULDER 2+ VIEWS BIL","code_information":[{"code":"73030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":864.96,"maximum":1333.35,"gross_charge":1632,"discounted_cash":373.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":864.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1333.35,"methodology":"fee schedule"}]}]},{"description":"XR SHOULDER 2+ VIEWS BIL","code_information":[{"code":"73030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.83,"maximum":1333.35,"gross_charge":1632,"discounted_cash":373.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":864.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1333.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR SHOULDER 2+ VIEWS RT","code_information":[{"code":"73030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":430.36,"maximum":663.41,"gross_charge":812,"discounted_cash":185.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":430.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":663.41,"methodology":"fee schedule"}]}]},{"description":"XR SHOULDER 2+ VIEWS RT","code_information":[{"code":"73030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.83,"maximum":663.41,"gross_charge":812,"discounted_cash":185.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":430.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":663.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM SHOULDER RT","code_information":[{"code":"73040","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":882.98,"maximum":1361.13,"gross_charge":1666,"discounted_cash":381.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":882.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1361.13,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM SHOULDER RT","code_information":[{"code":"73040","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":138.04,"maximum":1361.13,"gross_charge":1666,"discounted_cash":381.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1033.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1033.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":351.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":263.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":263.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":882.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1361.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR AC JOINTS W OR WO WTS BIL","code_information":[{"code":"73050","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":325.95,"maximum":502.46,"gross_charge":615,"discounted_cash":140.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":325.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":502.46,"methodology":"fee schedule"}]}]},{"description":"XR AC JOINTS W OR WO WTS BIL","code_information":[{"code":"73050","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.4,"maximum":502.46,"gross_charge":615,"discounted_cash":140.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":325.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":502.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR HUMERUS 1 VIEW LTD LT","code_information":[{"code":"73060","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":385.84,"maximum":594.78,"gross_charge":728,"discounted_cash":166.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":385.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":594.78,"methodology":"fee schedule"}]}]},{"description":"XR HUMERUS 1 VIEW LTD LT","code_information":[{"code":"73060","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.62,"maximum":594.78,"gross_charge":728,"discounted_cash":166.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":385.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":594.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR HUMERUS 2+ VIEWS RT","code_information":[{"code":"73060","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":448.38,"maximum":691.19,"gross_charge":846,"discounted_cash":193.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":448.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":691.19,"methodology":"fee schedule"}]}]},{"description":"XR HUMERUS 2+ VIEWS RT","code_information":[{"code":"73060","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.62,"maximum":691.19,"gross_charge":846,"discounted_cash":193.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":448.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":691.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 1 VIEW LTD LT","code_information":[{"code":"73070","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":320.65,"maximum":494.29,"gross_charge":605,"discounted_cash":138.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":320.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":494.29,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 1 VIEW LTD LT","code_information":[{"code":"73070","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":494.29,"gross_charge":605,"discounted_cash":138.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":320.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":494.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 2 VIEWS BIL","code_information":[{"code":"73070","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":653.49,"maximum":1007.37,"gross_charge":1233,"discounted_cash":282.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":653.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1007.37,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 2 VIEWS BIL","code_information":[{"code":"73070","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":1007.37,"gross_charge":1233,"discounted_cash":282.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":653.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1007.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 2 VIEWS RT","code_information":[{"code":"73070","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":341.32,"maximum":526.15,"gross_charge":644,"discounted_cash":147.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":341.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":526.15,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 2 VIEWS RT","code_information":[{"code":"73070","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":526.15,"gross_charge":644,"discounted_cash":147.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":341.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":526.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 3+ VIEWS BIL","code_information":[{"code":"73080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":726.1,"maximum":1119.29,"gross_charge":1370,"discounted_cash":313.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":726.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1119.29,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 3+ VIEWS BIL","code_information":[{"code":"73080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.69,"maximum":1119.29,"gross_charge":1370,"discounted_cash":313.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":726.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1119.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 3+ VIEWS RT","code_information":[{"code":"73080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":405.45,"maximum":625.01,"gross_charge":765,"discounted_cash":175.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":405.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":625.01,"methodology":"fee schedule"}]}]},{"description":"XR ELBOW 3+ VIEWS RT","code_information":[{"code":"73080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.69,"maximum":625.01,"gross_charge":765,"discounted_cash":175.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":405.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":625.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM ELBOW RT","code_information":[{"code":"73085","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":878.21,"maximum":1353.77,"gross_charge":1657,"discounted_cash":379.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":878.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1353.77,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM ELBOW RT","code_information":[{"code":"73085","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":104.78,"maximum":1353.77,"gross_charge":1657,"discounted_cash":379.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":841.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":841.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":185.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":185.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":878.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1353.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR FOREARM 1VIEW LTD LT","code_information":[{"code":"73090","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":233.73,"maximum":360.3,"gross_charge":441,"discounted_cash":100.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":233.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":360.3,"methodology":"fee schedule"}]}]},{"description":"XR FOREARM 1VIEW LTD LT","code_information":[{"code":"73090","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":360.3,"gross_charge":441,"discounted_cash":100.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":233.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":360.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FOREARM 2 VIEWS BIL","code_information":[{"code":"73090","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":543.78,"maximum":838.25,"gross_charge":1026,"discounted_cash":234.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":543.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":838.25,"methodology":"fee schedule"}]}]},{"description":"XR FOREARM 2 VIEWS BIL","code_information":[{"code":"73090","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":838.25,"gross_charge":1026,"discounted_cash":234.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":543.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":838.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FOREARM 2 VIEWS RT","code_information":[{"code":"73090","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":362.52,"maximum":558.83,"gross_charge":684,"discounted_cash":156.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":362.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":558.83,"methodology":"fee schedule"}]}]},{"description":"XR FOREARM 2 VIEWS RT","code_information":[{"code":"73090","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":558.83,"gross_charge":684,"discounted_cash":156.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":362.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":558.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR UPP EXTREM INFANT 2+ VWS RT","code_information":[{"code":"73092","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":202.99,"maximum":312.92,"gross_charge":383,"discounted_cash":87.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":202.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.92,"methodology":"fee schedule"}]}]},{"description":"XR UPP EXTREM INFANT 2+ VWS RT","code_information":[{"code":"73092","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.26,"maximum":383.01,"gross_charge":383,"discounted_cash":87.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":202.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"HOLTER MONITOR/TELEMETRY","code_information":[{"code":"731","type":"RC"}],"standard_charges":[{"minimum":1295,"maximum":1761,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1543,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1295,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1761,"methodology":"case rate"}]}]},{"description":"XR WRIST 1 VIEW LTD LT","code_information":[{"code":"73100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":264.47,"maximum":407.69,"gross_charge":499,"discounted_cash":114.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":264.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":407.69,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 1 VIEW LTD LT","code_information":[{"code":"73100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.76,"maximum":407.69,"gross_charge":499,"discounted_cash":114.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":264.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":407.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 2 VIEWS BIL","code_information":[{"code":"73100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":588.83,"maximum":907.69,"gross_charge":1111,"discounted_cash":254.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":588.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":907.69,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 2 VIEWS BIL","code_information":[{"code":"73100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.76,"maximum":907.69,"gross_charge":1111,"discounted_cash":254.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":588.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":907.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 2 VIEWS RT","code_information":[{"code":"73100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":305.28,"maximum":470.6,"gross_charge":576,"discounted_cash":131.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":305.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":470.6,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 2 VIEWS RT","code_information":[{"code":"73100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.76,"maximum":470.6,"gross_charge":576,"discounted_cash":131.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":305.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":470.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 3+ VIEWS BIL","code_information":[{"code":"73110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":705.96,"maximum":1088.25,"gross_charge":1332,"discounted_cash":305.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":705.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1088.25,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 3+ VIEWS BIL","code_information":[{"code":"73110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.27,"maximum":1088.25,"gross_charge":1332,"discounted_cash":305.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":314.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":314.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":84.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":84.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":705.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1088.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 3+ VIEWS RT","code_information":[{"code":"73110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":367.82,"maximum":567,"gross_charge":694,"discounted_cash":158.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":367.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"XR WRIST 3+ VIEWS RT","code_information":[{"code":"73110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.27,"maximum":567,"gross_charge":694,"discounted_cash":158.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":314.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":314.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":84.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":84.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":367.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM WRIST RT","code_information":[{"code":"73115","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":1018.66,"maximum":1570.28,"gross_charge":1922,"discounted_cash":440.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1018.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1570.28,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM WRIST RT","code_information":[{"code":"73115","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":141.62,"maximum":1570.28,"gross_charge":1922,"discounted_cash":440.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1078.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1078.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":266.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":266.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1018.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1570.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR HAND 1 VIEW LTD LT","code_information":[{"code":"73120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":340.26,"maximum":524.52,"gross_charge":642,"discounted_cash":147.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":340.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":524.52,"methodology":"fee schedule"}]}]},{"description":"XR HAND 1 VIEW LTD LT","code_information":[{"code":"73120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.26,"maximum":524.52,"gross_charge":642,"discounted_cash":147.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":223.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":340.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":524.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR HAND 2 VIEWS BIL","code_information":[{"code":"73120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":629.64,"maximum":970.6,"gross_charge":1188,"discounted_cash":272.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":629.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":970.6,"methodology":"fee schedule"}]}]},{"description":"XR HAND 2 VIEWS BIL","code_information":[{"code":"73120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.26,"maximum":970.6,"gross_charge":1188,"discounted_cash":272.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":223.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":629.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":970.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR HAND 2 VIEWS RT","code_information":[{"code":"73120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":324.36,"maximum":500.01,"gross_charge":612,"discounted_cash":140.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":324.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.01,"methodology":"fee schedule"}]}]},{"description":"XR HAND 2 VIEWS RT","code_information":[{"code":"73120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.26,"maximum":500.01,"gross_charge":612,"discounted_cash":140.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":223.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":324.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR HAND 3+ VIEWS BIL","code_information":[{"code":"73130","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":742,"maximum":1143.8,"gross_charge":1400,"discounted_cash":320.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":742,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1143.8,"methodology":"fee schedule"}]}]},{"description":"XR HAND 3+ VIEWS BIL","code_information":[{"code":"73130","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.98,"maximum":1143.8,"gross_charge":1400,"discounted_cash":320.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":742,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1143.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR HAND 3+ VIEWS RT","code_information":[{"code":"73130","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":386.37,"maximum":595.6,"gross_charge":729,"discounted_cash":166.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":595.6,"methodology":"fee schedule"}]}]},{"description":"XR HAND 3+ VIEWS RT","code_information":[{"code":"73130","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.98,"maximum":595.6,"gross_charge":729,"discounted_cash":166.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":595.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FINGER(S) 2+ VIEWS RT","code_information":[{"code":"73140","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":291.5,"maximum":449.35,"gross_charge":550,"discounted_cash":125.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":291.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":449.35,"methodology":"fee schedule"}]}]},{"description":"XR FINGER(S) 2+ VIEWS RT","code_information":[{"code":"73140","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":40.05,"maximum":449.35,"gross_charge":550,"discounted_cash":125.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":298.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":298.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":291.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":449.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"HOLTER MONITOR/TELEMETRY","code_information":[{"code":"732","type":"RC"}],"standard_charges":[{"minimum":1295,"maximum":1761,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1543,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1295,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1761,"methodology":"case rate"}]}]},{"description":"CT UPPER EXTREMITY WO CON RT","code_information":[{"code":"73200","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1106.64,"maximum":1705.9,"gross_charge":2088,"discounted_cash":478.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1106.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1705.9,"methodology":"fee schedule"}]}]},{"description":"CT UPPER EXTREMITY WO CON RT","code_information":[{"code":"73200","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1705.9,"gross_charge":2088,"discounted_cash":478.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":374.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":374.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1106.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1705.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT UPPER EXTREMITY W CON RT","code_information":[{"code":"73201","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1471.81,"maximum":2268.81,"gross_charge":2777,"discounted_cash":635.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1471.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2268.81,"methodology":"fee schedule"}]}]},{"description":"CT UPPER EXTREMITY W CON RT","code_information":[{"code":"73201","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":216,"maximum":2268.81,"gross_charge":2777,"discounted_cash":635.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":674.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":505.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":505.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1471.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2268.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO UPP EXTREM W RT","code_information":[{"code":"73206","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1132.08,"maximum":1745.12,"gross_charge":2136,"discounted_cash":489.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1132.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1745.12,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO UPP EXTREM W RT","code_information":[{"code":"73206","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":1745.12,"gross_charge":2136,"discounted_cash":489.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":625.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":625.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1132.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1745.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREMITY WO CON RT","code_information":[{"code":"73218","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1087.56,"maximum":1676.49,"gross_charge":2052,"discounted_cash":469.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1087.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1676.49,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREMITY WO CON RT","code_information":[{"code":"73218","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":257.63,"maximum":1698,"gross_charge":2052,"discounted_cash":469.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1099.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":824.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":824.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1087.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1676.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREMITY W CON RT","code_information":[{"code":"73219","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1936.09,"maximum":2984.51,"gross_charge":3653,"discounted_cash":836.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1936.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2984.51,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREMITY W CON RT","code_information":[{"code":"73219","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":357.62,"maximum":2984.51,"gross_charge":3653,"discounted_cash":836.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1174.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":881.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":881.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1936.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2984.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREMITY WO W CON RT","code_information":[{"code":"73220","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2200.56,"maximum":3392.19,"gross_charge":4152,"discounted_cash":950.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2200.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3392.19,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREMITY WO W CON RT","code_information":[{"code":"73220","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":380.64,"maximum":3392.19,"gross_charge":4152,"discounted_cash":950.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1421.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1066.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1066.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2200.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3392.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR UPP EXTREM JOINT WO CON LT","code_information":[{"code":"73221","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1732.57,"maximum":2670.78,"gross_charge":3269,"discounted_cash":748.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1732.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2670.78,"methodology":"fee schedule"}]}]},{"description":"MR UPP EXTREM JOINT WO CON LT","code_information":[{"code":"73221","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":219.22,"maximum":2670.78,"gross_charge":3269,"discounted_cash":748.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":650.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1732.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2670.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREM JOINT W CON LT","code_information":[{"code":"73222","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2348.43,"maximum":3620.13,"gross_charge":4431,"discounted_cash":1014.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2348.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3620.13,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREM JOINT W CON LT","code_information":[{"code":"73222","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":338.31,"maximum":3620.13,"gross_charge":4431,"discounted_cash":1014.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1085.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":814.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":814.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2348.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3620.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREM JOINT W CON RT","code_information":[{"code":"73222","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1853.94,"maximum":2857.87,"gross_charge":3498,"discounted_cash":801.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1853.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2857.87,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREM JOINT W CON RT","code_information":[{"code":"73222","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":338.31,"maximum":2857.87,"gross_charge":3498,"discounted_cash":801.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1085.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":814.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":814.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1853.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2857.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREMITY JNT WO W RT","code_information":[{"code":"73223","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2044.21,"maximum":3151.17,"gross_charge":3857,"discounted_cash":883.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2044.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3151.17,"methodology":"fee schedule"}]}]},{"description":"MR UPPER EXTREMITY JNT WO W RT","code_information":[{"code":"73223","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":380.64,"maximum":3151.17,"gross_charge":3857,"discounted_cash":883.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1311.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":983.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":983.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2044.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3151.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"minimum":17534.29,"maximum":45218.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41174,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41174,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30719.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23040.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23040.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39837.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32852.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45218.89,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17534.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17709.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18060.32,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17884.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17534.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17534.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17534.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17972.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17534.29,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"minimum":10660.41,"maximum":77249.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25814,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25814,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77249.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57938.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57938.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24976.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20596.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28349.74,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10660.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10767.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10980.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10873.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10660.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10660.41,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10660.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10926.93,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10660.41,"methodology":"case rate"}]}]},{"description":"XR HIP W WO PELVIS 1 VIEW LT","code_information":[{"code":"73501","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":303.69,"maximum":468.15,"gross_charge":573,"discounted_cash":131.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":303.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":468.15,"methodology":"fee schedule"}]}]},{"description":"XR HIP W WO PELVIS 1 VIEW LT","code_information":[{"code":"73501","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.69,"maximum":468.15,"gross_charge":573,"discounted_cash":131.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":227.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":227.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":303.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":468.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR HIP UNIL W WO PELV 2-3VW LT","code_information":[{"code":"73502","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":303.69,"maximum":468.15,"gross_charge":573,"discounted_cash":131.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":303.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":468.15,"methodology":"fee schedule"}]}]},{"description":"XR HIP UNIL W WO PELV 2-3VW LT","code_information":[{"code":"73502","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":50.07,"maximum":468.15,"gross_charge":573,"discounted_cash":131.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":350.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":303.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":468.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR HIP W WO PELVIS 2VIEWS BIL","code_information":[{"code":"73521","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":500.85,"maximum":772.07,"gross_charge":945,"discounted_cash":216.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":500.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":772.07,"methodology":"fee schedule"}]}]},{"description":"XR HIP W WO PELVIS 2VIEWS BIL","code_information":[{"code":"73521","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.27,"maximum":772.07,"gross_charge":945,"discounted_cash":216.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":295.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":295.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":500.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":772.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR HIP W PELVIS 3-4 VIEWS BIL","code_information":[{"code":"73522","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":500.85,"maximum":772.07,"gross_charge":945,"discounted_cash":216.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":500.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":772.07,"methodology":"fee schedule"}]}]},{"description":"XR HIP W PELVIS 3-4 VIEWS BIL","code_information":[{"code":"73522","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":56.5,"maximum":772.07,"gross_charge":945,"discounted_cash":216.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":102.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":102.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":500.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":772.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM HIP RT","code_information":[{"code":"73525","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":1008.59,"maximum":1554.76,"gross_charge":1903,"discounted_cash":435.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1008.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1554.76,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM HIP RT","code_information":[{"code":"73525","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":135.18,"maximum":1554.76,"gross_charge":1903,"discounted_cash":435.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1042.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1042.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":331.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":248.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":248.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1008.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1554.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR FEMUR 1 VIEW LT","code_information":[{"code":"73551","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":208.82,"maximum":321.9,"gross_charge":394,"discounted_cash":90.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":208.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":321.9,"methodology":"fee schedule"}]}]},{"description":"XR FEMUR 1 VIEW LT","code_information":[{"code":"73551","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":321.9,"gross_charge":394,"discounted_cash":90.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":208.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":321.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FEMUR 2+ VIEWS BIL","code_information":[{"code":"73552","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":858.07,"maximum":1322.73,"gross_charge":1619,"discounted_cash":370.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":858.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1322.73,"methodology":"fee schedule"}]}]},{"description":"XR FEMUR 2+ VIEWS BIL","code_information":[{"code":"73552","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":37.55,"maximum":1322.73,"gross_charge":1619,"discounted_cash":370.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":69.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":69.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":858.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1322.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FEMUR 2+ VIEWS RT","code_information":[{"code":"73552","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":444.67,"maximum":685.47,"gross_charge":839,"discounted_cash":192.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":444.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":685.47,"methodology":"fee schedule"}]}]},{"description":"XR FEMUR 2+ VIEWS RT","code_information":[{"code":"73552","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":37.55,"maximum":685.47,"gross_charge":839,"discounted_cash":192.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":69.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":69.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":444.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":685.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 1 OR 2 VIEWS BIL","code_information":[{"code":"73560","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":553.85,"maximum":853.77,"gross_charge":1045,"discounted_cash":239.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":553.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":853.77,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 1 OR 2 VIEWS BIL","code_information":[{"code":"73560","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.12,"maximum":853.77,"gross_charge":1045,"discounted_cash":239.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":553.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":853.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 1 OR 2 VIEWS RT","code_information":[{"code":"73560","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":368.88,"maximum":568.64,"gross_charge":696,"discounted_cash":159.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":368.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":568.64,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 1 OR 2 VIEWS RT","code_information":[{"code":"73560","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.12,"maximum":568.64,"gross_charge":696,"discounted_cash":159.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":368.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":568.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 3 VIEWS BIL","code_information":[{"code":"73562","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":864.43,"maximum":1332.53,"gross_charge":1631,"discounted_cash":373.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":864.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1332.53,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 3 VIEWS BIL","code_information":[{"code":"73562","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.91,"maximum":1332.53,"gross_charge":1631,"discounted_cash":373.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":864.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1332.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 3 VIEWS RT","code_information":[{"code":"73562","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":449.97,"maximum":693.64,"gross_charge":849,"discounted_cash":194.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":449.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":693.64,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 3 VIEWS RT","code_information":[{"code":"73562","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.91,"maximum":693.64,"gross_charge":849,"discounted_cash":194.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":449.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":693.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 4+ VIEWS RT","code_information":[{"code":"73564","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":769.56,"maximum":1186.29,"gross_charge":1452,"discounted_cash":332.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":769.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1186.29,"methodology":"fee schedule"}]}]},{"description":"XR KNEE 4+ VIEWS RT","code_information":[{"code":"73564","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":49.71,"maximum":1186.29,"gross_charge":1452,"discounted_cash":332.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":344.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":344.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":93.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":93.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":769.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1186.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR KNEE AP STANDING BIL","code_information":[{"code":"73565","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":553.85,"maximum":853.77,"gross_charge":1045,"discounted_cash":239.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":553.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":853.77,"methodology":"fee schedule"}]}]},{"description":"XR KNEE AP STANDING BIL","code_information":[{"code":"73565","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.84,"maximum":853.77,"gross_charge":1045,"discounted_cash":239.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":311.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":553.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":853.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM KNEE RT","code_information":[{"code":"73580","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":878.21,"maximum":1353.77,"gross_charge":1657,"discounted_cash":379.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":878.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1353.77,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM KNEE RT","code_information":[{"code":"73580","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":115.87,"maximum":1353.77,"gross_charge":1657,"discounted_cash":379.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1179.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1179.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":878.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1353.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR TIBIA AND FIBULA 2 VIEW BIL","code_information":[{"code":"73590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":835.28,"maximum":1287.6,"gross_charge":1576,"discounted_cash":360.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":835.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1287.6,"methodology":"fee schedule"}]}]},{"description":"XR TIBIA AND FIBULA 2 VIEW BIL","code_information":[{"code":"73590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.26,"maximum":1287.6,"gross_charge":1576,"discounted_cash":360.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":835.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1287.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR TIBIA AND FIBULA 2 VIEWS RT","code_information":[{"code":"73590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":433.01,"maximum":667.49,"gross_charge":817,"discounted_cash":187.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":433.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":667.49,"methodology":"fee schedule"}]}]},{"description":"XR TIBIA AND FIBULA 2 VIEWS RT","code_information":[{"code":"73590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.26,"maximum":667.49,"gross_charge":817,"discounted_cash":187.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":433.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":667.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR TIBIA/FIBULA 1 VIEW LTD LT","code_information":[{"code":"73590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":402.27,"maximum":620.11,"gross_charge":759,"discounted_cash":173.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":402.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":620.11,"methodology":"fee schedule"}]}]},{"description":"XR TIBIA/FIBULA 1 VIEW LTD LT","code_information":[{"code":"73590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.26,"maximum":620.11,"gross_charge":759,"discounted_cash":173.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":402.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":620.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR LOW EXTREM INFANT 2+ VWS RT","code_information":[{"code":"73592","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":200.34,"maximum":308.83,"gross_charge":378,"discounted_cash":86.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":200.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.83,"methodology":"fee schedule"}]}]},{"description":"XR LOW EXTREM INFANT 2+ VWS RT","code_information":[{"code":"73592","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.26,"maximum":311.33,"gross_charge":378,"discounted_cash":86.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":200.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"minimum":31722.84,"maximum":89140.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81168,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50575.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37932.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37932.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":78532.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":64761.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":89140.16,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31722.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32040.07,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32674.53,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32357.3,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31722.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31722.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31722.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32515.92,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31722.84,"methodology":"case rate"}]}]},{"description":"XR ANKLE 1 VIEW LTD LT","code_information":[{"code":"73600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":368.35,"maximum":567.82,"gross_charge":695,"discounted_cash":159.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":368.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":567.82,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 1 VIEW LTD LT","code_information":[{"code":"73600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.97,"maximum":567.82,"gross_charge":695,"discounted_cash":159.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":368.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":567.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 2 VIEWS BIL","code_information":[{"code":"73600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":529.47,"maximum":816.19,"gross_charge":999,"discounted_cash":228.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":529.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":816.19,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 2 VIEWS BIL","code_information":[{"code":"73600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.97,"maximum":816.19,"gross_charge":999,"discounted_cash":228.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":529.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":816.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 2 VIEWS RT","code_information":[{"code":"73600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":352.98,"maximum":544.13,"gross_charge":666,"discounted_cash":152.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":352.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":544.13,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 2 VIEWS RT","code_information":[{"code":"73600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.97,"maximum":544.13,"gross_charge":666,"discounted_cash":152.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":352.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":544.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 3+ VIEWS BIL","code_information":[{"code":"73610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1037.21,"maximum":1598.87,"gross_charge":1957,"discounted_cash":448.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1037.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1598.87,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 3+ VIEWS BIL","code_information":[{"code":"73610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.27,"maximum":1598.87,"gross_charge":1957,"discounted_cash":448.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":275.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":71.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":71.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1037.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1598.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 3+ VIEWS RT","code_information":[{"code":"73610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":518.87,"maximum":799.85,"gross_charge":979,"discounted_cash":224.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":518.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":799.85,"methodology":"fee schedule"}]}]},{"description":"XR ANKLE 3+ VIEWS RT","code_information":[{"code":"73610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.27,"maximum":799.85,"gross_charge":979,"discounted_cash":224.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":275.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":71.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":71.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":518.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":799.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM ANKLE RT","code_information":[{"code":"73615","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":767.97,"maximum":1183.84,"gross_charge":1449,"discounted_cash":331.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":767.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1183.84,"methodology":"fee schedule"}]}]},{"description":"XR ARTHROGRAM ANKLE RT","code_information":[{"code":"73615","type":"CPT"},{"code":"0322","type":"RC"}],"standard_charges":[{"minimum":134.11,"maximum":1320.24,"gross_charge":1449,"discounted_cash":331.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1039.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1039.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":249.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":249.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":767.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1183.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 1 VIEW LTD LT","code_information":[{"code":"73620","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":200.34,"maximum":308.83,"gross_charge":378,"discounted_cash":86.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":200.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.83,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 1 VIEW LTD LT","code_information":[{"code":"73620","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.04,"maximum":311.33,"gross_charge":378,"discounted_cash":86.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":200.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 2 VIEWS BIL","code_information":[{"code":"73620","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":451.03,"maximum":695.27,"gross_charge":851,"discounted_cash":194.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":451.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":695.27,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 2 VIEWS BIL","code_information":[{"code":"73620","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.04,"maximum":695.27,"gross_charge":851,"discounted_cash":194.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":451.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":695.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 2 VIEWS RT","code_information":[{"code":"73620","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":300.51,"maximum":463.24,"gross_charge":567,"discounted_cash":129.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":300.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":463.24,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 2 VIEWS RT","code_information":[{"code":"73620","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.04,"maximum":463.24,"gross_charge":567,"discounted_cash":129.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":300.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":463.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 3+ VIEWS BIL","code_information":[{"code":"73630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":582.47,"maximum":897.89,"gross_charge":1099,"discounted_cash":251.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":582.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":897.89,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 3+ VIEWS BIL","code_information":[{"code":"73630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.12,"maximum":897.89,"gross_charge":1099,"discounted_cash":251.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":582.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":897.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 3+ VIEWS RT","code_information":[{"code":"73630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":356.16,"maximum":549.03,"gross_charge":672,"discounted_cash":153.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":356.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":549.03,"methodology":"fee schedule"}]}]},{"description":"XR FOOT 3+ VIEWS RT","code_information":[{"code":"73630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.12,"maximum":549.03,"gross_charge":672,"discounted_cash":153.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":356.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":549.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR CALCANEUS 2+ VIEWS BIL","code_information":[{"code":"73650","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":452.62,"maximum":697.72,"gross_charge":854,"discounted_cash":195.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":452.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":697.72,"methodology":"fee schedule"}]}]},{"description":"XR CALCANEUS 2+ VIEWS BIL","code_information":[{"code":"73650","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.04,"maximum":697.72,"gross_charge":854,"discounted_cash":195.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":452.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":697.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR CALCANEUS 2+ VIEWS RT","code_information":[{"code":"73650","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":235.85,"maximum":363.57,"gross_charge":445,"discounted_cash":101.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":235.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":363.57,"methodology":"fee schedule"}]}]},{"description":"XR CALCANEUS 2+ VIEWS RT","code_information":[{"code":"73650","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.04,"maximum":363.57,"gross_charge":445,"discounted_cash":101.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":235.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":363.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR TOE(S) 2+ VIEWS RT","code_information":[{"code":"73660","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":297.33,"maximum":458.34,"gross_charge":561,"discounted_cash":128.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":297.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":458.34,"methodology":"fee schedule"}]}]},{"description":"XR TOE(S) 2+ VIEWS RT","code_information":[{"code":"73660","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":458.34,"gross_charge":561,"discounted_cash":128.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":297.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":458.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"minimum":16726.96,"maximum":40993.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37327,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37327,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40306.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30230.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30230.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":36115.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29782.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40993.87,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16726.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16894.23,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17228.77,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17061.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16726.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16726.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16726.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17145.14,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16726.96,"methodology":"case rate"}]}]},{"description":"CT LOWER EXTREMITY WO CON BIL","code_information":[{"code":"73700","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1337.19,"maximum":2061.3,"gross_charge":2523,"discounted_cash":577.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1337.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2061.3,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY WO CON BIL","code_information":[{"code":"73700","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":2061.3,"gross_charge":2523,"discounted_cash":577.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1337.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2061.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY WO CON RT","code_information":[{"code":"73700","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1044.63,"maximum":1610.31,"gross_charge":1971,"discounted_cash":451.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1044.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1610.31,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY WO CON RT","code_information":[{"code":"73700","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1610.31,"gross_charge":1971,"discounted_cash":451.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1044.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1610.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY W CON BIL","code_information":[{"code":"73701","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1410.33,"maximum":2174.04,"gross_charge":2661,"discounted_cash":609.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1410.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2174.04,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY W CON BIL","code_information":[{"code":"73701","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":179.52,"maximum":2174.04,"gross_charge":2661,"discounted_cash":609.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":391.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":391.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1410.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2174.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY W CON RT","code_information":[{"code":"73701","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1128.37,"maximum":1739.4,"gross_charge":2129,"discounted_cash":487.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1128.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1739.4,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY W CON RT","code_information":[{"code":"73701","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":179.52,"maximum":1739.4,"gross_charge":2129,"discounted_cash":487.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":391.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":391.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1128.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1739.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREM WO W CON BIL","code_information":[{"code":"73702","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2006.05,"maximum":3092.35,"gross_charge":3785,"discounted_cash":866.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2006.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3092.35,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREM WO W CON BIL","code_information":[{"code":"73702","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":3092.35,"gross_charge":3785,"discounted_cash":866.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":642.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":482.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":482.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2006.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3092.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY WO W CON RT","code_information":[{"code":"73702","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1598.48,"maximum":2464.08,"gross_charge":3016,"discounted_cash":690.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1598.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2464.08,"methodology":"fee schedule"}]}]},{"description":"CT LOWER EXTREMITY WO W CON RT","code_information":[{"code":"73702","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":2464.08,"gross_charge":3016,"discounted_cash":690.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":642.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":482.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":482.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1598.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2464.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO LOW EXTREM W BIL","code_information":[{"code":"73706","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1278.36,"maximum":1970.61,"gross_charge":2412,"discounted_cash":552.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1278.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1970.61,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO LOW EXTREM W BIL","code_information":[{"code":"73706","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":1977.81,"gross_charge":2412,"discounted_cash":552.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1977.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1977.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":625.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":625.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1278.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1970.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO LOW EXTREM W RT","code_information":[{"code":"73706","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1065.3,"maximum":1642.17,"gross_charge":2010,"discounted_cash":460.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1065.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1642.17,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO LOW EXTREM W RT","code_information":[{"code":"73706","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":1977.81,"gross_charge":2010,"discounted_cash":460.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1977.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1977.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":625.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":625.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1065.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1642.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY WO CON RT","code_information":[{"code":"73718","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1628.69,"maximum":2510.65,"gross_charge":3073,"discounted_cash":703.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1628.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.65,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY WO CON RT","code_information":[{"code":"73718","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":241.03,"maximum":2510.65,"gross_charge":3073,"discounted_cash":703.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":738.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":553.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":553.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1628.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY W CON RT","code_information":[{"code":"73719","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2410.97,"maximum":3716.54,"gross_charge":4549,"discounted_cash":1041.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2410.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3716.54,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY W CON RT","code_information":[{"code":"73719","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":283.95,"maximum":3716.54,"gross_charge":4549,"discounted_cash":1041.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":865.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":649.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":649.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2410.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3716.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY WO W CON RT","code_information":[{"code":"73720","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2720.49,"maximum":4193.67,"gross_charge":5133,"discounted_cash":1175.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2720.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4193.67,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY WO W CON RT","code_information":[{"code":"73720","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":364.05,"maximum":4193.67,"gross_charge":5133,"discounted_cash":1175.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1091.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":818.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":818.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2720.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4193.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY JOINT WO BI","code_information":[{"code":"73721","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2211.69,"maximum":3409.35,"gross_charge":4173,"discounted_cash":955.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2211.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3409.35,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY JOINT WO BI","code_information":[{"code":"73721","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":218.86,"maximum":3409.35,"gross_charge":4173,"discounted_cash":955.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":486.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":486.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2211.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3409.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY JOINT WO LT","code_information":[{"code":"73721","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":1525.34,"maximum":2351.33,"gross_charge":2878,"discounted_cash":659.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1525.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2351.33,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY JOINT WO LT","code_information":[{"code":"73721","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":218.86,"maximum":2351.33,"gross_charge":2878,"discounted_cash":659.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":486.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":486.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1525.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2351.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY JOINT W RT","code_information":[{"code":"73722","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":3004.57,"maximum":4631.58,"gross_charge":5669,"discounted_cash":1298.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3004.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4631.58,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY JOINT W RT","code_information":[{"code":"73722","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":338.66,"maximum":4631.58,"gross_charge":5669,"discounted_cash":1298.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1092.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":819.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":819.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3004.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4631.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1716.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY JNT WO W RT","code_information":[{"code":"73723","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":3965.46,"maximum":6112.8,"gross_charge":7482,"discounted_cash":1713.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3965.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6112.8,"methodology":"fee schedule"}]}]},{"description":"MR LOWER EXTREMITY JNT WO W RT","code_information":[{"code":"73723","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":380.64,"maximum":6112.8,"gross_charge":7482,"discounted_cash":1713.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1306.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":980.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":980.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3965.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6112.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"minimum":13003.52,"maximum":50073.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25902,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25902,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50073.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37556.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37556.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25061.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20666.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28446.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13003.52,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13133.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13393.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13263.6,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13003.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13003.52,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13003.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13328.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13003.52,"methodology":"case rate"}]}]},{"description":"EKG/ECG","code_information":[{"code":"739","type":"RC"}],"standard_charges":[{"minimum":297,"maximum":360,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":351,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":297,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":360,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"minimum":24792.49,"maximum":77249.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70340,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70340,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33056.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24792.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24792.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":68056.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":56122.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":77249.03,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32057.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32378.26,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33019.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32698.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32057.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32057.68,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32057.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32859.13,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32057.68,"methodology":"case rate"}]}]},{"description":"EEG","code_information":[{"code":"740","type":"RC"}],"standard_charges":[{"minimum":935,"maximum":1267,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1111,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":935,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1267,"methodology":"case rate"}]}]},{"description":"SLEEP STUDIES","code_information":[{"code":"740","type":"RC"}],"standard_charges":[{"minimum":2010,"maximum":2434,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2405,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2434,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"minimum":15334.25,"maximum":36822.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33529,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33529,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23375.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17532.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17532.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32440.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26752.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36822.48,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15334.25,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15487.6,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15794.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15640.94,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15334.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15334.25,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15334.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15717.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15334.25,"methodology":"case rate"}]}]},{"description":"MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"7401","type":"APR-DRG"}],"standard_charges":[{"minimum":8149,"maximum":8149,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8149,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8149,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8149,"methodology":"case rate"}]}]},{"description":"XR ABDOMEN 1 VIEW","code_information":[{"code":"74018","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":400.68,"maximum":617.66,"gross_charge":756,"discounted_cash":173.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":400.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":617.66,"methodology":"fee schedule"}]}]},{"description":"XR ABDOMEN 1 VIEW","code_information":[{"code":"74018","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":31.83,"maximum":617.66,"gross_charge":756,"discounted_cash":173.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":400.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":617.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"XR ABDOMEN 2 VIEWS","code_information":[{"code":"74019","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":456.33,"maximum":703.44,"gross_charge":861,"discounted_cash":197.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":456.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":703.44,"methodology":"fee schedule"}]}]},{"description":"XR ABDOMEN 2 VIEWS","code_information":[{"code":"74019","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.62,"maximum":703.44,"gross_charge":861,"discounted_cash":197.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":456.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":703.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"7402","type":"APR-DRG"}],"standard_charges":[{"minimum":8238,"maximum":8238,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8238,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8238,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8238,"methodology":"case rate"}]}]},{"description":"XR ABDOMEN 3 OR MORE VIEWS","code_information":[{"code":"74021","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":511.98,"maximum":789.23,"gross_charge":966,"discounted_cash":221.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":511.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":789.23,"methodology":"fee schedule"}]}]},{"description":"XR ABDOMEN 3 OR MORE VIEWS","code_information":[{"code":"74021","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":45.06,"maximum":789.23,"gross_charge":966,"discounted_cash":221.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":295.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":295.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":511.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":789.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR ABD COMPLETE 2+VW/SNG CHEST","code_information":[{"code":"74022","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":481.77,"maximum":742.66,"gross_charge":909,"discounted_cash":208.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":481.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":742.66,"methodology":"fee schedule"}]}]},{"description":"XR ABD COMPLETE 2+VW/SNG CHEST","code_information":[{"code":"74022","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":52.57,"maximum":742.66,"gross_charge":909,"discounted_cash":208.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":481.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":742.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"7403","type":"APR-DRG"}],"standard_charges":[{"minimum":17440,"maximum":17440,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17440,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17440,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17440,"methodology":"case rate"}]}]},{"description":"MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"7404","type":"APR-DRG"}],"standard_charges":[{"minimum":22801,"maximum":22801,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22801,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22801,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22801,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"minimum":11895.37,"maximum":29816.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24974,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24974,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29816.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22362.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22362.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24163.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19926.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27427.58,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11895.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12014.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12252.24,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12133.28,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11895.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11895.37,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11895.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12192.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11895.37,"methodology":"case rate"}]}]},{"description":"CT ABDOMEN WO CON","code_information":[{"code":"74150","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1594.24,"maximum":2457.54,"gross_charge":3008,"discounted_cash":688.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1594.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2457.54,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN WO CON","code_information":[{"code":"74150","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":2457.54,"gross_charge":3008,"discounted_cash":688.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":282,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":282,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1594.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2457.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN W CON","code_information":[{"code":"74160","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2571.03,"maximum":3963.27,"gross_charge":4851,"discounted_cash":1110.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3963.27,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN W CON","code_information":[{"code":"74160","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":3963.27,"gross_charge":4851,"discounted_cash":1110.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":792.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":594.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":594.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3963.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN WO AND W CON","code_information":[{"code":"74170","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":3059.69,"maximum":4716.55,"gross_charge":5773,"discounted_cash":1322.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3059.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4716.55,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN WO AND W CON","code_information":[{"code":"74170","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":4716.55,"gross_charge":5773,"discounted_cash":1322.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3059.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4716.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO ABDOMEN/PELVIS W CON","code_information":[{"code":"74174","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":4111.21,"maximum":6337.47,"gross_charge":7757,"discounted_cash":1776.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4111.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6337.47,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO ABDOMEN/PELVIS W CON","code_information":[{"code":"74174","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":380.64,"maximum":6337.47,"gross_charge":7757,"discounted_cash":1776.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1283.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":963.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":963.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4111.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6337.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO ABDOMEN W CON","code_information":[{"code":"74175","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":3247.84,"maximum":5006.58,"gross_charge":6128,"discounted_cash":1403.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3247.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5006.58,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO ABDOMEN W CON","code_information":[{"code":"74175","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":5006.58,"gross_charge":6128,"discounted_cash":1403.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3247.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5006.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN PELVIS WO CON","code_information":[{"code":"74176","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2778.79,"maximum":4283.54,"gross_charge":5243,"discounted_cash":1200.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2778.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4283.54,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN PELVIS WO CON","code_information":[{"code":"74176","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":197.4,"maximum":4283.54,"gross_charge":5243,"discounted_cash":1200.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":475.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":356.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":356.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2778.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4283.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN PELVIS W CON","code_information":[{"code":"74177","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":4027.47,"maximum":6208.39,"gross_charge":7599,"discounted_cash":1740.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4027.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6208.39,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN PELVIS W CON","code_information":[{"code":"74177","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":326.86,"maximum":6208.39,"gross_charge":7599,"discounted_cash":1740.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1002.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":751.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":751.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4027.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6208.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN PELVIS W WO CON","code_information":[{"code":"74178","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":4671.95,"maximum":7201.86,"gross_charge":8815,"discounted_cash":2018.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4671.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7201.86,"methodology":"fee schedule"}]}]},{"description":"CT ABDOMEN PELVIS W WO CON","code_information":[{"code":"74178","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":366.56,"maximum":7201.86,"gross_charge":8815,"discounted_cash":2018.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1130.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":848.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":848.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4671.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7201.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ABDOMEN WO CON","code_information":[{"code":"74181","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":2201.62,"maximum":3393.82,"gross_charge":4154,"discounted_cash":951.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2201.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3393.82,"methodology":"fee schedule"}]}]},{"description":"MR ABDOMEN WO CON","code_information":[{"code":"74181","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":211.35,"maximum":3393.82,"gross_charge":4154,"discounted_cash":951.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":591.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":443.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":443.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2201.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3393.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ABDOMEN W CON","code_information":[{"code":"74182","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":3302.43,"maximum":5090.73,"gross_charge":6231,"discounted_cash":1426.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3302.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5090.73,"methodology":"fee schedule"}]}]},{"description":"MR ABDOMEN W CON","code_information":[{"code":"74182","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":326.5,"maximum":5090.73,"gross_charge":6231,"discounted_cash":1426.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1024.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":768.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":768.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3302.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5090.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ABDOMEN WO AND W CON","code_information":[{"code":"74183","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":4491.22,"maximum":6923.26,"gross_charge":8474,"discounted_cash":1940.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4491.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6923.26,"methodology":"fee schedule"}]}]},{"description":"MR ABDOMEN WO AND W CON","code_information":[{"code":"74183","type":"CPT"},{"code":"0614","type":"RC"}],"standard_charges":[{"minimum":365.13,"maximum":6923.26,"gross_charge":8474,"discounted_cash":1940.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1086.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":815.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":815.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4491.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6923.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"minimum":15399.21,"maximum":34854.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31737,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31737,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20814.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15611.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15611.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30706.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25322.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34854.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15399.21,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15553.21,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15861.19,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15707.2,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15399.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15399.21,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15399.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15784.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15399.21,"methodology":"case rate"}]}]},{"description":"XR ESOPHAGUS SCOUT CHEST W CON","code_information":[{"code":"74220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":594.13,"maximum":915.86,"gross_charge":1121,"discounted_cash":256.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":594.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":915.86,"methodology":"fee schedule"}]}]},{"description":"XR ESOPHAGUS SCOUT CHEST W CON","code_information":[{"code":"74220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":102.28,"maximum":915.86,"gross_charge":1121,"discounted_cash":256.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":701.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":701.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":173.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":173.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":594.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":915.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"XR SWL FUNCT/CINE/VID/SCT WCON","code_information":[{"code":"74230","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":378.42,"maximum":583.34,"gross_charge":714,"discounted_cash":163.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":378.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":583.34,"methodology":"fee schedule"}]}]},{"description":"XR SWL FUNCT/CINE/VID/SCT WCON","code_information":[{"code":"74230","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":130.53,"maximum":1020.26,"gross_charge":714,"discounted_cash":163.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1020.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":248.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":248.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":378.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":583.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"XR UGI/SCOUT ABD W SINGLE CON","code_information":[{"code":"74240","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":577.17,"maximum":889.72,"gross_charge":1089,"discounted_cash":249.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":577.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":889.72,"methodology":"fee schedule"}]}]},{"description":"XR UGI/SCOUT ABD W SINGLE CON","code_information":[{"code":"74240","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":128.74,"maximum":889.72,"gross_charge":1089,"discounted_cash":249.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":857.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":857.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":577.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":889.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"XR UGI/SCOUT ABD W DOUBLE CON","code_information":[{"code":"74246","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":640.77,"maximum":987.76,"gross_charge":1209,"discounted_cash":276.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":640.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":987.76,"methodology":"fee schedule"}]}]},{"description":"XR UGI/SCOUT ABD W DOUBLE CON","code_information":[{"code":"74246","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":145.91,"maximum":987.76,"gross_charge":1209,"discounted_cash":276.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":987.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":987.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":242.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":640.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":987.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"XR SM INT FL THRU MLT SRL IMG","code_information":[{"code":"74248","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":68.37,"maximum":105.4,"gross_charge":129,"discounted_cash":29.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"}]}]},{"description":"XR SM INT FL THRU MLT SRL IMG","code_information":[{"code":"74248","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":68.37,"maximum":503.47,"gross_charge":129,"discounted_cash":29.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":503.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":503.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":123.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":123.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"}]}]},{"description":"XR SMALL INTESTINE/SCOUT W CON","code_information":[{"code":"74250","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":456.33,"maximum":703.44,"gross_charge":861,"discounted_cash":197.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":456.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":703.44,"methodology":"fee schedule"}]}]},{"description":"XR SMALL INTESTINE/SCOUT W CON","code_information":[{"code":"74250","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":127.67,"maximum":851.22,"gross_charge":861,"discounted_cash":197.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":851.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":851.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":210.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":210.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":456.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":703.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"XR SMALL INTESTINE/SCT W DBCON","code_information":[{"code":"74251","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1752.18,"maximum":2701.01,"gross_charge":3306,"discounted_cash":757.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1752.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2701.01,"methodology":"fee schedule"}]}]},{"description":"XR SMALL INTESTINE/SCT W DBCON","code_information":[{"code":"74251","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":2701.01,"gross_charge":3306,"discounted_cash":757.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1715.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1715.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":628.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":471.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":471.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1752.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2701.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"XR COLON/SCOUT W CONTRAST","code_information":[{"code":"74270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":520.99,"maximum":803.12,"gross_charge":983,"discounted_cash":225.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":520.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.12,"methodology":"fee schedule"}]}]},{"description":"XR COLON/SCOUT W CONTRAST","code_information":[{"code":"74270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":160.93,"maximum":1062.45,"gross_charge":983,"discounted_cash":225.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1062.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1062.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":262.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":262.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":520.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"XR COLON/SCOUT W DB CONTRAST","code_information":[{"code":"74280","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":729.28,"maximum":1124.2,"gross_charge":1376,"discounted_cash":315.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":729.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1124.2,"methodology":"fee schedule"}]}]},{"description":"XR COLON/SCOUT W DB CONTRAST","code_information":[{"code":"74280","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":1637.73,"gross_charge":1376,"discounted_cash":315.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1637.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1637.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":533.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":400.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":400.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":729.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1124.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"XR ENEMA TX INTRALUM OBSTRUCT","code_information":[{"code":"74283","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":906.3,"maximum":1397.07,"gross_charge":1710,"discounted_cash":391.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":906.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1397.07,"methodology":"fee schedule"}]}]},{"description":"XR ENEMA TX INTRALUM OBSTRUCT","code_information":[{"code":"74283","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":1575.98,"gross_charge":1710,"discounted_cash":391.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1575.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1575.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":409.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":409.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":646.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":906.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1397.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"minimum":10542.87,"maximum":24514.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21574,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21574,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24514.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18386.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18386.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20873.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17213.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23693.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10542.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10648.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10859.16,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10753.73,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10542.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10542.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10542.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10806.45,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10542.87,"methodology":"case rate"}]}]},{"description":"XR CHOLANGIO/PANC INTRAOP","code_information":[{"code":"74300","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":958.24,"maximum":1477.14,"gross_charge":1808,"discounted_cash":414.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":958.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1477.14,"methodology":"fee schedule"}]}]},{"description":"XR CHOLANGIO/PANC INTRAOP","code_information":[{"code":"74300","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":18.33,"maximum":1477.14,"gross_charge":1808,"discounted_cash":414.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":958.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1477.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"}]}]},{"description":"XR CHOLANG/PANC INTRAOP EA ADD","code_information":[{"code":"74301","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":430.89,"maximum":664.23,"gross_charge":813,"discounted_cash":186.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":430.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":664.23,"methodology":"fee schedule"}]}]},{"description":"XR CHOLANG/PANC INTRAOP EA ADD","code_information":[{"code":"74301","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":11.92,"maximum":664.23,"gross_charge":813,"discounted_cash":186.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":430.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":664.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"}]}]},{"description":"XR ENDO BILIARY PANCREAT CATH","code_information":[{"code":"74330","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1076.43,"maximum":1659.33,"gross_charge":2031,"discounted_cash":465.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1076.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1659.33,"methodology":"fee schedule"}]}]},{"description":"XR ENDO BILIARY PANCREAT CATH","code_information":[{"code":"74330","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":44.51,"maximum":1659.33,"gross_charge":2031,"discounted_cash":465.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":746.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":746.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1076.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1659.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.59,"methodology":"fee schedule"}]}]},{"description":"D&C CONIZATION LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"minimum":13383.94,"maximum":35906.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32695,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32695,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17844.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13383.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13383.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31633.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26086.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35906.51,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16383.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16547.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16875.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16711.3,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16383.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16383.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16383.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16793.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16383.62,"methodology":"case rate"}]}]},{"description":"XR UROGRAM RETROGRADE","code_information":[{"code":"74420","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":592.54,"maximum":913.41,"gross_charge":1118,"discounted_cash":256.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":592.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":913.41,"methodology":"fee schedule"}]}]},{"description":"XR UROGRAM RETROGRADE","code_information":[{"code":"74420","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":81.89,"maximum":1320.24,"gross_charge":1118,"discounted_cash":256.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":509.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":509.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":592.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":913.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR UROGRAM ANTEGRADE LT","code_information":[{"code":"74425","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":677.34,"maximum":1044.13,"gross_charge":1278,"discounted_cash":292.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":677.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1044.13,"methodology":"fee schedule"}]}]},{"description":"XR UROGRAM ANTEGRADE LT","code_information":[{"code":"74425","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":142.33,"maximum":1320.24,"gross_charge":1278,"discounted_cash":292.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1124.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1124.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":677.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1044.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR CYSTOGRAM 3+ VIEWS","code_information":[{"code":"74430","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":663.03,"maximum":1022.07,"gross_charge":1251,"discounted_cash":286.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":663.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1022.07,"methodology":"fee schedule"}]}]},{"description":"XR CYSTOGRAM 3+ VIEWS","code_information":[{"code":"74430","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.27,"maximum":1320.24,"gross_charge":1251,"discounted_cash":286.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":67.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":67.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1320.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":663.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1022.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"XR CYSTOURETHROGRAM RETROGRADE","code_information":[{"code":"74450","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":627.52,"maximum":967.33,"gross_charge":1184,"discounted_cash":271.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":627.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":967.33,"methodology":"fee schedule"}]}]},{"description":"XR CYSTOURETHROGRAM RETROGRADE","code_information":[{"code":"74450","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":20.62,"maximum":2206.49,"gross_charge":1184,"discounted_cash":271.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2206.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2206.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":852.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":639.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":639.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":627.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":967.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"XR CYSTOURETHROGRAM VOIDING","code_information":[{"code":"74455","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":592.54,"maximum":913.41,"gross_charge":1118,"discounted_cash":256.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":592.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":913.41,"methodology":"fee schedule"}]}]},{"description":"XR CYSTOURETHROGRAM VOIDING","code_information":[{"code":"74455","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":109.07,"maximum":913.41,"gross_charge":1118,"discounted_cash":256.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":886.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":886.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":294.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":220.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":220.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":592.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":913.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"D&C CONIZATION LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"minimum":9198.1,"maximum":25521.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20011,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20011,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25521.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19141.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19141.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19361.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15966.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21977.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9198.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9290.09,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9474.05,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9382.07,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9198.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9198.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9198.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9428.06,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9198.1,"methodology":"case rate"}]}]},{"description":"VAGINA CERVIX AND VULVA PROCEDURES WITH CC/MCC","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"minimum":14223.01,"maximum":33647.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30638,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30638,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20679.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15509.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15509.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29643.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24445.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33647.53,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14223.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14365.25,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14649.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14507.48,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14223.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14223.01,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14223.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14578.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14223.01,"methodology":"case rate"}]}]},{"description":"VAGINA CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"minimum":8659.88,"maximum":19231.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17511,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17511,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18827.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14121.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14121.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16942.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13971.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19231.28,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8659.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8746.48,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8919.68,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8833.08,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8659.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8659.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8659.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8876.38,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8659.88,"methodology":"case rate"}]}]},{"description":"XR HYSTEROSALPINGOGRAM","code_information":[{"code":"74740","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":939.16,"maximum":1447.73,"gross_charge":1772,"discounted_cash":405.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":939.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1447.73,"methodology":"fee schedule"}]}]},{"description":"XR HYSTEROSALPINGOGRAM","code_information":[{"code":"74740","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":98.34,"maximum":1447.73,"gross_charge":1772,"discounted_cash":405.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":779.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":779.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":185.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":185.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":939.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1447.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"minimum":11807.99,"maximum":31827.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24828,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31827.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23870.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23870.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24021.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19809.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27266.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11807.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11926.07,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12162.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12044.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11807.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11807.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11807.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12103.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11807.99,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"minimum":15689.02,"maximum":53477.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48694,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48694,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20918.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15689.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15689.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":47113.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38851.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":53477.08,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21290.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21503.9,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21929.72,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21716.81,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21290.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21290.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21290.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21823.27,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21290.99,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"minimum":11245.03,"maximum":33291.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25006,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25006,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33291.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24969,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24969,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24194.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19952.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27462.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11245.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11357.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11582.39,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11469.94,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11245.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11245.03,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11245.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11526.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11245.03,"methodology":"case rate"}]}]},{"description":"SCHIZOPHRENIA","code_information":[{"code":"7501","type":"APR-DRG"}],"standard_charges":[{"minimum":3809,"maximum":3809,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3809,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3809,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3809,"methodology":"case rate"}]}]},{"description":"ENDO PROC UP TO 20 MIN","code_information":[{"code":"7501000698","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1941.39,"maximum":2992.68,"gross_charge":3663,"discounted_cash":838.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1941.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2992.68,"methodology":"fee schedule"}]}]},{"description":"ENDO PROC UP TO 20 MIN","code_information":[{"code":"7501000698","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1941.39,"maximum":2992.68,"gross_charge":3663,"discounted_cash":838.83,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1941.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2992.68,"methodology":"fee schedule"}]}]},{"description":"ENDO PROC EACH ADDL 10 MIN","code_information":[{"code":"7501000699","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":399.62,"maximum":616.02,"gross_charge":754,"discounted_cash":172.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":399.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":616.02,"methodology":"fee schedule"}]}]},{"description":"ENDO PROC EACH ADDL 10 MIN","code_information":[{"code":"7501000699","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":399.62,"maximum":616.02,"gross_charge":754,"discounted_cash":172.67,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":399.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":616.02,"methodology":"fee schedule"}]}]},{"description":"SCHIZOPHRENIA","code_information":[{"code":"7502","type":"APR-DRG"}],"standard_charges":[{"minimum":4618,"maximum":4618,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4618,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4618,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4618,"methodology":"case rate"}]}]},{"description":"SCHIZOPHRENIA","code_information":[{"code":"7503","type":"APR-DRG"}],"standard_charges":[{"minimum":7712,"maximum":7712,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7712,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7712,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7712,"methodology":"case rate"}]}]},{"description":"SCHIZOPHRENIA","code_information":[{"code":"7504","type":"APR-DRG"}],"standard_charges":[{"minimum":16859,"maximum":16859,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16859,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16859,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16859,"methodology":"case rate"}]}]},{"description":"MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES","code_information":[{"code":"7511","type":"APR-DRG"}],"standard_charges":[{"minimum":2290,"maximum":2290,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2290,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2290,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2290,"methodology":"case rate"}]}]},{"description":"MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES","code_information":[{"code":"7512","type":"APR-DRG"}],"standard_charges":[{"minimum":3186,"maximum":3186,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3186,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3186,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3186,"methodology":"case rate"}]}]},{"description":"MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES","code_information":[{"code":"7513","type":"APR-DRG"}],"standard_charges":[{"minimum":6263,"maximum":6263,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6263,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6263,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6263,"methodology":"case rate"}]}]},{"description":"MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES","code_information":[{"code":"7514","type":"APR-DRG"}],"standard_charges":[{"minimum":11537,"maximum":11537,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11537,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11537,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11537,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"7521","type":"APR-DRG"}],"standard_charges":[{"minimum":2060,"maximum":2060,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2060,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2060,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2060,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"7522","type":"APR-DRG"}],"standard_charges":[{"minimum":2675,"maximum":2675,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2675,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2675,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2675,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"7523","type":"APR-DRG"}],"standard_charges":[{"minimum":6189,"maximum":6189,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6189,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6189,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6189,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"7524","type":"APR-DRG"}],"standard_charges":[{"minimum":6189,"maximum":6189,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6189,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6189,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6189,"methodology":"case rate"}]}]},{"description":"BIPOLAR DISORDERS","code_information":[{"code":"7531","type":"APR-DRG"}],"standard_charges":[{"minimum":2531,"maximum":2531,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2531,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2531,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2531,"methodology":"case rate"}]}]},{"description":"BIPOLAR DISORDERS","code_information":[{"code":"7532","type":"APR-DRG"}],"standard_charges":[{"minimum":3480,"maximum":3480,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3480,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3480,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3480,"methodology":"case rate"}]}]},{"description":"BIPOLAR DISORDERS","code_information":[{"code":"7533","type":"APR-DRG"}],"standard_charges":[{"minimum":6117,"maximum":6117,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6117,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6117,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6117,"methodology":"case rate"}]}]},{"description":"BIPOLAR DISORDERS","code_information":[{"code":"7534","type":"APR-DRG"}],"standard_charges":[{"minimum":11968,"maximum":11968,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11968,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11968,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11968,"methodology":"case rate"}]}]},{"description":"MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WITH MCC","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"minimum":15264.65,"maximum":36347.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33097,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33097,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24777.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18583.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18583.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32022.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26407.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36347.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15264.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15417.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15722.59,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15569.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15264.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15264.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15264.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15646.27,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15264.65,"methodology":"case rate"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER","code_information":[{"code":"7541","type":"APR-DRG"}],"standard_charges":[{"minimum":1942,"maximum":1942,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1942,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1942,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1942,"methodology":"case rate"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER","code_information":[{"code":"7542","type":"APR-DRG"}],"standard_charges":[{"minimum":2697,"maximum":2697,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2697,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2697,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2697,"methodology":"case rate"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER","code_information":[{"code":"7543","type":"APR-DRG"}],"standard_charges":[{"minimum":4594,"maximum":4594,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4594,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4594,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4594,"methodology":"case rate"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER","code_information":[{"code":"7544","type":"APR-DRG"}],"standard_charges":[{"minimum":10350,"maximum":10350,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10350,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10350,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10350,"methodology":"case rate"}]}]},{"description":"MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WITH CC","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"minimum":9857.72,"maximum":21120.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19232,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19232,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16439.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12330.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12330.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18607.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15344.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21120.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9857.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9956.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10153.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10054.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9857.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9857.72,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9857.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10104.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9857.72,"methodology":"case rate"}]}]},{"description":"ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES","code_information":[{"code":"7551","type":"APR-DRG"}],"standard_charges":[{"minimum":1799,"maximum":1799,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1799,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1799,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1799,"methodology":"case rate"}]}]},{"description":"ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES","code_information":[{"code":"7552","type":"APR-DRG"}],"standard_charges":[{"minimum":2730,"maximum":2730,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2730,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2730,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2730,"methodology":"case rate"}]}]},{"description":"ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES","code_information":[{"code":"7553","type":"APR-DRG"}],"standard_charges":[{"minimum":4218,"maximum":4218,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4218,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4218,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4218,"methodology":"case rate"}]}]},{"description":"ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES","code_information":[{"code":"7554","type":"APR-DRG"}],"standard_charges":[{"minimum":11564,"maximum":11564,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11564,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11564,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11564,"methodology":"case rate"}]}]},{"description":"CT HRT EVAL COR CA WO CON","code_information":[{"code":"75571","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1720.91,"maximum":2652.8,"gross_charge":3247,"discounted_cash":743.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2652.8,"methodology":"fee schedule"}]}]},{"description":"CT HRT EVAL COR CA WO CON","code_information":[{"code":"75571","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":93.85,"maximum":2652.8,"gross_charge":3247,"discounted_cash":743.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":339.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":254.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":254.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2652.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"CT HRT STRC/MORP/3D W CON","code_information":[{"code":"75572","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1904.82,"maximum":2936.3,"gross_charge":3594,"discounted_cash":823.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1904.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2936.3,"methodology":"fee schedule"}]}]},{"description":"CT HRT STRC/MORP/3D W CON","code_information":[{"code":"75572","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":245.33,"maximum":2936.3,"gross_charge":3594,"discounted_cash":823.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":511.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":511.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1904.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2936.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"CT HRT STRC/MORP CONGENTL","code_information":[{"code":"75573","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1904.82,"maximum":2936.3,"gross_charge":3594,"discounted_cash":823.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1904.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2936.3,"methodology":"fee schedule"}]}]},{"description":"CT HRT STRC/MORP CONGENTL","code_information":[{"code":"75573","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":327.22,"maximum":2936.3,"gross_charge":3594,"discounted_cash":823.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":869.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":652.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":652.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1904.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2936.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO HRT/COR ART 3D W CON","code_information":[{"code":"75574","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":2363.8,"maximum":3643.82,"gross_charge":4460,"discounted_cash":1021.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2363.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3643.82,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO HRT/COR ART 3D W CON","code_information":[{"code":"75574","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":346.53,"maximum":3643.82,"gross_charge":4460,"discounted_cash":1021.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":735.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":735.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2363.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3643.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"CT EST CORONARY FFR SW ANLY","code_information":[{"code":"75580","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":3490.05,"maximum":5379.95,"gross_charge":6585,"discounted_cash":1507.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3490.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5379.95,"methodology":"fee schedule"}]}]},{"description":"CT EST CORONARY FFR SW ANLY","code_information":[{"code":"75580","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1839,"maximum":8220.27,"gross_charge":6585,"discounted_cash":1507.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8220.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8220.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2451.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1839,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1839,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3490.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5379.95,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"minimum":8658.33,"maximum":19942.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16470,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16470,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19942.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14957,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14957,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15935.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13141.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18088.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8658.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8744.92,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8918.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8831.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8658.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8658.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8658.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8874.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8658.33,"methodology":"case rate"}]}]},{"description":"ACUTE ANXIETY AND DELIRIUM STATES","code_information":[{"code":"7561","type":"APR-DRG"}],"standard_charges":[{"minimum":2856,"maximum":2856,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2856,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2856,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2856,"methodology":"case rate"}]}]},{"description":"ACUTE ANXIETY AND DELIRIUM STATES","code_information":[{"code":"7562","type":"APR-DRG"}],"standard_charges":[{"minimum":3647,"maximum":3647,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3647,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3647,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3647,"methodology":"case rate"}]}]},{"description":"ACUTE ANXIETY AND DELIRIUM STATES","code_information":[{"code":"7563","type":"APR-DRG"}],"standard_charges":[{"minimum":3815,"maximum":3815,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3815,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3815,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3815,"methodology":"case rate"}]}]},{"description":"CT ANGIO AORTA W RUNOFF","code_information":[{"code":"75635","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2215.93,"maximum":3415.88,"gross_charge":4181,"discounted_cash":957.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2215.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3415.88,"methodology":"fee schedule"}]}]},{"description":"CT ANGIO AORTA W RUNOFF","code_information":[{"code":"75635","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":3415.88,"gross_charge":4181,"discounted_cash":957.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":625.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2215.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3415.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":393.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":393.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":191.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":195.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":193.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"}]}]},{"description":"ACUTE ANXIETY AND DELIRIUM STATES","code_information":[{"code":"7564","type":"APR-DRG"}],"standard_charges":[{"minimum":10340,"maximum":10340,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10340,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10340,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10340,"methodology":"case rate"}]}]},{"description":"INFECTIONS FEMALE REPRODUCTIVE SYSTEM WITH MCC","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"minimum":11636.97,"maximum":29300.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26680,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26680,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15515.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11636.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11636.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25813.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21287.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29300.78,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12217.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12340.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12584.38,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12462.2,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12217.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12217.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12217.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12523.29,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12217.84,"methodology":"case rate"}]}]},{"description":"ORGANIC MENTAL HEALTH DISTURBANCES","code_information":[{"code":"7571","type":"APR-DRG"}],"standard_charges":[{"minimum":2919,"maximum":2919,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2919,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2919,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2919,"methodology":"case rate"}]}]},{"description":"ORGANIC MENTAL HEALTH DISTURBANCES","code_information":[{"code":"7572","type":"APR-DRG"}],"standard_charges":[{"minimum":3885,"maximum":3885,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3885,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3885,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3885,"methodology":"case rate"}]}]},{"description":"ORGANIC MENTAL HEALTH DISTURBANCES","code_information":[{"code":"7573","type":"APR-DRG"}],"standard_charges":[{"minimum":7361,"maximum":7361,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7361,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7361,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7361,"methodology":"case rate"}]}]},{"description":"ORGANIC MENTAL HEALTH DISTURBANCES","code_information":[{"code":"7574","type":"APR-DRG"}],"standard_charges":[{"minimum":14093,"maximum":14093,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14093,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14093,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14093,"methodology":"case rate"}]}]},{"description":"INFECTIONS FEMALE REPRODUCTIVE SYSTEM WITH CC","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"minimum":9155.57,"maximum":19916.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18135,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18135,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13373.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10030.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10030.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17546.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14469.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19916.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9155.57,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9247.13,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9430.24,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9338.69,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9155.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9155.57,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9155.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9384.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9155.57,"methodology":"case rate"}]}]},{"description":"XR SHUNTOGRAM NONVASCULAR","code_information":[{"code":"75809","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":540.07,"maximum":832.53,"gross_charge":1019,"discounted_cash":233.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":540.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":832.53,"methodology":"fee schedule"}]}]},{"description":"XR SHUNTOGRAM NONVASCULAR","code_information":[{"code":"75809","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":85.83,"maximum":832.53,"gross_charge":1019,"discounted_cash":233.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":199.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":149.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":540.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":832.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"BEHAVIORAL DISORDERS","code_information":[{"code":"7581","type":"APR-DRG"}],"standard_charges":[{"minimum":2543,"maximum":2543,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2543,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2543,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2543,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL DISORDERS","code_information":[{"code":"7582","type":"APR-DRG"}],"standard_charges":[{"minimum":3247,"maximum":3247,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3247,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3247,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3247,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL DISORDERS","code_information":[{"code":"7583","type":"APR-DRG"}],"standard_charges":[{"minimum":5722,"maximum":5722,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5722,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5722,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5722,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL DISORDERS","code_information":[{"code":"7584","type":"APR-DRG"}],"standard_charges":[{"minimum":8799,"maximum":8799,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8799,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8799,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8799,"methodology":"case rate"}]}]},{"description":"INFECTIONS FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"minimum":6222.43,"maximum":17976.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12403,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12403,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17976.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13482.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13482.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12000.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9896.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13621.98,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6222.43,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6284.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6409.11,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6346.88,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6222.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6222.43,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6222.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6378,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6222.43,"methodology":"case rate"}]}]},{"description":"EATING DISORDERS","code_information":[{"code":"7591","type":"APR-DRG"}],"standard_charges":[{"minimum":7580,"maximum":7580,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7580,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7580,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7580,"methodology":"case rate"}]}]},{"description":"EATING DISORDERS","code_information":[{"code":"7592","type":"APR-DRG"}],"standard_charges":[{"minimum":7743,"maximum":7743,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7743,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7743,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7743,"methodology":"case rate"}]}]},{"description":"EATING DISORDERS","code_information":[{"code":"7593","type":"APR-DRG"}],"standard_charges":[{"minimum":10976,"maximum":10976,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10976,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10976,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10976,"methodology":"case rate"}]}]},{"description":"EATING DISORDERS","code_information":[{"code":"7594","type":"APR-DRG"}],"standard_charges":[{"minimum":27181,"maximum":27181,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27181,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27181,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27181,"methodology":"case rate"}]}]},{"description":"XR TUBE/CATH CHANGE W CON","code_information":[{"code":"75984","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":380.54,"maximum":586.61,"gross_charge":718,"discounted_cash":164.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":380.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":586.61,"methodology":"fee schedule"}]}]},{"description":"XR TUBE/CATH CHANGE W CON","code_information":[{"code":"75984","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":94.97,"maximum":586.61,"gross_charge":718,"discounted_cash":164.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":584.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":584.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":94.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":94.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":380.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":586.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.13,"methodology":"fee schedule"}]}]},{"description":"CT GUIDE CATH DRN ABSCES/SPEC","code_information":[{"code":"75989","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":1158.05,"maximum":1785.15,"gross_charge":2185,"discounted_cash":500.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1158.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1785.15,"methodology":"fee schedule"}]}]},{"description":"CT GUIDE CATH DRN ABSCES/SPEC","code_information":[{"code":"75989","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":117.3,"maximum":1785.15,"gross_charge":2185,"discounted_cash":500.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1158.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1785.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"}]}]},{"description":"XR FLUORO GUIDE CATH DRAIN","code_information":[{"code":"75989","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1105.05,"maximum":1703.45,"gross_charge":2085,"discounted_cash":477.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1105.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1703.45,"methodology":"fee schedule"}]}]},{"description":"XR FLUORO GUIDE CATH DRAIN","code_information":[{"code":"75989","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":117.3,"maximum":1703.45,"gross_charge":2085,"discounted_cash":477.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1105.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1703.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"minimum":8894.96,"maximum":18618.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16953,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16953,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14487.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10866.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10866.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16402.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13526.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18618.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8894.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8983.91,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9161.81,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9072.86,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8894.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8894.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8894.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9117.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8894.96,"methodology":"case rate"}]}]},{"description":"XR FLUOROSCOPY < 1 HR","code_information":[{"code":"76000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":519.4,"maximum":800.66,"gross_charge":980,"discounted_cash":224.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":519.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":800.66,"methodology":"fee schedule"}]}]},{"description":"XR FLUOROSCOPY < 1 HR","code_information":[{"code":"76000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":44.7,"maximum":836.78,"gross_charge":980,"discounted_cash":224.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":269.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":269.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":519.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":800.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"OTHER MENTAL HEALTH DISORDERS","code_information":[{"code":"7601","type":"APR-DRG"}],"standard_charges":[{"minimum":3627,"maximum":3627,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3627,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3627,"methodology":"case rate"}]}]},{"description":"XR NOSE TO RECTUM FB 1VW CHILD","code_information":[{"code":"76010","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":398.03,"maximum":613.57,"gross_charge":751,"discounted_cash":171.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":398.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":613.57,"methodology":"fee schedule"}]}]},{"description":"XR NOSE TO RECTUM FB 1VW CHILD","code_information":[{"code":"76010","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.76,"maximum":613.57,"gross_charge":751,"discounted_cash":171.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":398.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":613.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":195.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":195.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"OTHER MENTAL HEALTH DISORDERS","code_information":[{"code":"7602","type":"APR-DRG"}],"standard_charges":[{"minimum":4275,"maximum":4275,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4275,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4275,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4275,"methodology":"case rate"}]}]},{"description":"OTHER MENTAL HEALTH DISORDERS","code_information":[{"code":"7603","type":"APR-DRG"}],"standard_charges":[{"minimum":6087,"maximum":6087,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6087,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6087,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6087,"methodology":"case rate"}]}]},{"description":"OTHER MENTAL HEALTH DISORDERS","code_information":[{"code":"7604","type":"APR-DRG"}],"standard_charges":[{"minimum":7708,"maximum":7708,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7708,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7708,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7708,"methodology":"case rate"}]}]},{"description":"XR SINUS TRACT/FISTULA/ABSCESS","code_information":[{"code":"76080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":841.11,"maximum":1296.58,"gross_charge":1587,"discounted_cash":363.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":841.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1296.58,"methodology":"fee schedule"}]}]},{"description":"XR SINUS TRACT/FISTULA/ABSCESS","code_information":[{"code":"76080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":62.58,"maximum":1802.89,"gross_charge":1587,"discounted_cash":363.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":347.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":347.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":90.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":90.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1802.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1802.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":841.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1296.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1182.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1182.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1182.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":601.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"minimum":6175.26,"maximum":15363.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10621,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10621,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15363.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11522.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11522.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10276.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8474.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11664.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6175.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6237.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6360.52,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6298.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6175.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6175.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6175.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6329.65,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6175.26,"methodology":"case rate"}]}]},{"description":"INCIS/DRAIN/ASP LEVEL 1","code_information":[{"code":"7611000012","type":"CDM"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1317.05,"maximum":2030.25,"gross_charge":2485,"discounted_cash":569.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1317.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2030.25,"methodology":"fee schedule"}]}]},{"description":"INCIS/DRAIN/ASP LEVEL 1","code_information":[{"code":"7611000012","type":"CDM"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1317.05,"maximum":2030.25,"gross_charge":2485,"discounted_cash":569.07,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1317.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2030.25,"methodology":"fee schedule"}]}]},{"description":"THORACENTESIS/THORACOSTOM","code_information":[{"code":"7611000022","type":"CDM"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1203.63,"maximum":1855.41,"gross_charge":2271,"discounted_cash":520.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1203.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1855.41,"methodology":"fee schedule"}]}]},{"description":"THORACENTESIS/THORACOSTOM","code_information":[{"code":"7611000022","type":"CDM"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1203.63,"maximum":1855.41,"gross_charge":2271,"discounted_cash":520.06,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1203.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1855.41,"methodology":"fee schedule"}]}]},{"description":"INSERT CATH BLADDER","code_information":[{"code":"7611000025","type":"CDM"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":171.19,"maximum":263.9,"gross_charge":323,"discounted_cash":73.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.9,"methodology":"fee schedule"}]}]},{"description":"INSERT CATH BLADDER","code_information":[{"code":"7611000025","type":"CDM"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":171.19,"maximum":263.9,"gross_charge":323,"discounted_cash":73.97,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.9,"methodology":"fee schedule"}]}]},{"description":"INTUBATION ENDOTRACHEAL","code_information":[{"code":"7611000045","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":645.54,"maximum":995.11,"gross_charge":1218,"discounted_cash":278.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":645.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":995.11,"methodology":"fee schedule"}]}]},{"description":"INTUBATION ENDOTRACHEAL","code_information":[{"code":"7611000045","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":645.54,"maximum":995.11,"gross_charge":1218,"discounted_cash":278.93,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":645.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":995.11,"methodology":"fee schedule"}]}]},{"description":"BRONCHIAL ALVEOLAR LAVAGE","code_information":[{"code":"7611000665","type":"CDM"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":3527.15,"maximum":5437.14,"gross_charge":6655,"discounted_cash":1524,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3527.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5437.14,"methodology":"fee schedule"}]}]},{"description":"BRONCHIAL ALVEOLAR LAVAGE","code_information":[{"code":"7611000665","type":"CDM"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":3527.15,"maximum":5437.14,"gross_charge":6655,"discounted_cash":1524,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3527.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5437.14,"methodology":"fee schedule"}]}]},{"description":"MR CINERADIO/VIDEO IN ADDITION","code_information":[{"code":"76125","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":225.78,"maximum":348.05,"gross_charge":426,"discounted_cash":97.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":225.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":348.05,"methodology":"fee schedule"}]}]},{"description":"MR CINERADIO/VIDEO IN ADDITION","code_information":[{"code":"76125","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":16.27,"maximum":348.05,"gross_charge":426,"discounted_cash":97.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":274.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":274.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":225.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":348.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"}]}]},{"description":"OBSERVATION","code_information":[{"code":"762","type":"RC"}],"standard_charges":[{"minimum":3161,"maximum":4327,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":4313,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3161,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4327,"methodology":"case rate"}]}]},{"description":"CT 3D WO SEPARATE WORKSTATION","code_information":[{"code":"76376","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":663.56,"maximum":1022.89,"gross_charge":1252,"discounted_cash":286.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":663.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1022.89,"methodology":"fee schedule"}]}]},{"description":"CT 3D WO SEPARATE WORKSTATION","code_information":[{"code":"76376","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":26.11,"maximum":1482,"gross_charge":1252,"discounted_cash":286.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":663.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1022.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"}]}]},{"description":"MR 3D WO SEPARATE WORKSTATION","code_information":[{"code":"76376","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":663.56,"maximum":1022.89,"gross_charge":1252,"discounted_cash":286.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":663.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1022.89,"methodology":"fee schedule"}]}]},{"description":"MR 3D WO SEPARATE WORKSTATION","code_information":[{"code":"76376","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":26.11,"maximum":1698,"gross_charge":1252,"discounted_cash":286.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":663.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1022.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"}]}]},{"description":"CT 3D W SEPARATE WORKSTATION","code_information":[{"code":"76377","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":729.81,"maximum":1125.01,"gross_charge":1377,"discounted_cash":315.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":729.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1125.01,"methodology":"fee schedule"}]}]},{"description":"CT 3D W SEPARATE WORKSTATION","code_information":[{"code":"76377","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":81.89,"maximum":1482,"gross_charge":1377,"discounted_cash":315.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":729.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1125.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"}]}]},{"description":"MR 3D W SEPARATE WORKSTATION","code_information":[{"code":"76377","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":610.56,"maximum":941.19,"gross_charge":1152,"discounted_cash":263.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":610.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":941.19,"methodology":"fee schedule"}]}]},{"description":"MR 3D W SEPARATE WORKSTATION","code_information":[{"code":"76377","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":81.89,"maximum":1698,"gross_charge":1152,"discounted_cash":263.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":610.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":941.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.89,"methodology":"fee schedule"}]}]},{"description":"CT FOLLOW UP LTD OR LOCALIZED","code_information":[{"code":"76380","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":258.64,"maximum":398.7,"gross_charge":488,"discounted_cash":111.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":258.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":398.7,"methodology":"fee schedule"}]}]},{"description":"CT FOLLOW UP LTD OR LOCALIZED","code_information":[{"code":"76380","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":93.85,"maximum":1482,"gross_charge":488,"discounted_cash":111.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":300.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":300.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":258.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":398.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"US ENCEPHALOGRAM","code_information":[{"code":"76506","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":498.2,"maximum":767.98,"gross_charge":940,"discounted_cash":215.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":498.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":767.98,"methodology":"fee schedule"}]}]},{"description":"US ENCEPHALOGRAM","code_information":[{"code":"76506","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":831.66,"gross_charge":940,"discounted_cash":215.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":203.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":203.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":498.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":767.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US SOFT TISSUE HEAD AND NECK","code_information":[{"code":"76536","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":594.66,"maximum":916.68,"gross_charge":1122,"discounted_cash":256.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":594.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":916.68,"methodology":"fee schedule"}]}]},{"description":"US SOFT TISSUE HEAD AND NECK","code_information":[{"code":"76536","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":916.68,"gross_charge":1122,"discounted_cash":256.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":212.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":212.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":594.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":916.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US CHEST","code_information":[{"code":"76604","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":694.83,"maximum":1071.09,"gross_charge":1311,"discounted_cash":300.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":694.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1071.09,"methodology":"fee schedule"}]}]},{"description":"US CHEST","code_information":[{"code":"76604","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":60.08,"maximum":1071.09,"gross_charge":1311,"discounted_cash":300.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":298.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":298.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":694.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1071.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US BREAST COMPLETE BILATERAL","code_information":[{"code":"76641","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":833.16,"maximum":1284.33,"gross_charge":1572,"discounted_cash":359.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":833.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1284.33,"methodology":"fee schedule"}]}]},{"description":"US BREAST COMPLETE BILATERAL","code_information":[{"code":"76641","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":108,"maximum":1284.33,"gross_charge":1572,"discounted_cash":359.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":672.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":672.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":172.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":172.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":833.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1284.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US BREAST COMPLETE RT","code_information":[{"code":"76641","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":418.17,"maximum":644.62,"gross_charge":789,"discounted_cash":180.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":418.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":644.62,"methodology":"fee schedule"}]}]},{"description":"US BREAST COMPLETE RT","code_information":[{"code":"76641","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":108,"maximum":672.41,"gross_charge":789,"discounted_cash":180.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":672.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":672.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":172.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":172.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":418.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":644.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US BREAST LIMITED BILATERAL","code_information":[{"code":"76642","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":332.84,"maximum":513.08,"gross_charge":628,"discounted_cash":143.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":332.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":513.08,"methodology":"fee schedule"}]}]},{"description":"US BREAST LIMITED BILATERAL","code_information":[{"code":"76642","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":89.4,"maximum":513.25,"gross_charge":628,"discounted_cash":143.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":513.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":332.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":513.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"US BREAST LIMITED RT","code_information":[{"code":"76642","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":229.49,"maximum":353.77,"gross_charge":433,"discounted_cash":99.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":229.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":353.77,"methodology":"fee schedule"}]}]},{"description":"US BREAST LIMITED RT","code_information":[{"code":"76642","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":89.4,"maximum":513.25,"gross_charge":433,"discounted_cash":99.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":513.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":229.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":353.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"US ABDOMEN COMPLETE WO CON","code_information":[{"code":"76700","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1105.58,"maximum":1704.27,"gross_charge":2086,"discounted_cash":477.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1105.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1704.27,"methodology":"fee schedule"}]}]},{"description":"US ABDOMEN COMPLETE WO CON","code_information":[{"code":"76700","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1704.27,"gross_charge":2086,"discounted_cash":477.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":776.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":776.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1105.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1704.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US ABDOMEN WO CON LIMITED","code_information":[{"code":"76705","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":961.42,"maximum":1482.04,"gross_charge":1814,"discounted_cash":415.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":961.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1482.04,"methodology":"fee schedule"}]}]},{"description":"US ABDOMEN WO CON LIMITED","code_information":[{"code":"76705","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":91.19,"maximum":1482.04,"gross_charge":1814,"discounted_cash":415.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":584.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":584.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":961.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1482.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US RETROPERITONEAL COMPLETE","code_information":[{"code":"76770","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":858.6,"maximum":1323.54,"gross_charge":1620,"discounted_cash":370.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":858.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1323.54,"methodology":"fee schedule"}]}]},{"description":"US RETROPERITONEAL COMPLETE","code_information":[{"code":"76770","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1323.54,"gross_charge":1620,"discounted_cash":370.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":724.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":724.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":858.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1323.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US RETROPERITONEAL LIMITED","code_information":[{"code":"76775","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":506.68,"maximum":781.06,"gross_charge":956,"discounted_cash":218.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":506.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":781.06,"methodology":"fee schedule"}]}]},{"description":"US RETROPERITONEAL LIMITED","code_information":[{"code":"76775","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":62.58,"maximum":781.06,"gross_charge":956,"discounted_cash":218.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":295.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":295.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":506.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":781.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"minimum":5937,"maximum":23745.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18925,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18925,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23745.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17809.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17809.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":7081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5937,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20784.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9751.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9848.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10043.55,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9946.04,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9751.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9751.01,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9751.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9994.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9751.01,"methodology":"case rate"}]}]},{"description":"US PREG<14WK SNGL OR 1ST GEST","code_information":[{"code":"76801","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":833.16,"maximum":1284.33,"gross_charge":1572,"discounted_cash":359.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":833.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1284.33,"methodology":"fee schedule"}]}]},{"description":"US PREG<14WK SNGL OR 1ST GEST","code_information":[{"code":"76801","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1284.33,"gross_charge":1572,"discounted_cash":359.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":691.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":691.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":178.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":178.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":833.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1284.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US PREG<14WKS EA ADD GEST","code_information":[{"code":"76802","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":308.46,"maximum":475.5,"gross_charge":582,"discounted_cash":133.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":308.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":475.5,"methodology":"fee schedule"}]}]},{"description":"US PREG<14WKS EA ADD GEST","code_information":[{"code":"76802","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":53.06,"maximum":475.5,"gross_charge":582,"discounted_cash":133.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":308.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":475.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"}]}]},{"description":"US PREG=>14WK SNG 1ST GES","code_information":[{"code":"76805","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":558.09,"maximum":860.31,"gross_charge":1053,"discounted_cash":241.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":558.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":860.31,"methodology":"fee schedule"}]}]},{"description":"US PREG=>14WK SNG 1ST GES","code_information":[{"code":"76805","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":861,"gross_charge":1053,"discounted_cash":241.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":861,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":861,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":223.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":223.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":558.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":860.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US PREG=>14WKS EA ADD GEST","code_information":[{"code":"76810","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":373.12,"maximum":575.17,"gross_charge":704,"discounted_cash":161.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":373.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":575.17,"methodology":"fee schedule"}]}]},{"description":"US PREG=>14WKS EA ADD GEST","code_information":[{"code":"76810","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":92.27,"maximum":575.17,"gross_charge":704,"discounted_cash":161.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":405.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":405.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":103.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":103.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":373.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":575.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.27,"methodology":"fee schedule"}]}]},{"description":"US PREG 1 OR >FETUSES LTD","code_information":[{"code":"76815","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":400.68,"maximum":617.66,"gross_charge":756,"discounted_cash":173.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":400.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":617.66,"methodology":"fee schedule"}]}]},{"description":"US PREG 1 OR >FETUSES LTD","code_information":[{"code":"76815","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":85.11,"maximum":617.66,"gross_charge":756,"discounted_cash":173.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":493.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":128.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":128.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":400.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":617.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US PREG TRANSVAGINAL","code_information":[{"code":"76817","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":734.58,"maximum":1132.37,"gross_charge":1386,"discounted_cash":317.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":734.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1132.37,"methodology":"fee schedule"}]}]},{"description":"US PREG TRANSVAGINAL","code_information":[{"code":"76817","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":97.27,"maximum":1132.37,"gross_charge":1386,"discounted_cash":317.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":558.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":558.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":734.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1132.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US TRANSVAGINAL","code_information":[{"code":"76830","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":734.58,"maximum":1132.37,"gross_charge":1386,"discounted_cash":317.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":734.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1132.37,"methodology":"fee schedule"}]}]},{"description":"US TRANSVAGINAL","code_information":[{"code":"76830","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1132.37,"gross_charge":1386,"discounted_cash":317.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":854.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":854.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":123.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":123.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":734.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1132.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US PELVIS NON OBSTETRIC COMP","code_information":[{"code":"76856","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1018.66,"maximum":1570.28,"gross_charge":1922,"discounted_cash":440.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1018.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1570.28,"methodology":"fee schedule"}]}]},{"description":"US PELVIS NON OBSTETRIC COMP","code_information":[{"code":"76856","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":110.5,"maximum":1570.28,"gross_charge":1922,"discounted_cash":440.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":717.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":717.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":185.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":185.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1018.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1570.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US PELVIS NON OB LTD OR F/U","code_information":[{"code":"76857","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":692.71,"maximum":1067.82,"gross_charge":1307,"discounted_cash":299.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":692.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1067.82,"methodology":"fee schedule"}]}]},{"description":"US PELVIS NON OB LTD OR F/U","code_information":[{"code":"76857","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":51.85,"maximum":1067.82,"gross_charge":1307,"discounted_cash":299.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":68.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":68.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":692.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1067.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US SCROTUM","code_information":[{"code":"76870","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":895.7,"maximum":1380.73,"gross_charge":1690,"discounted_cash":387.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":895.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1380.73,"methodology":"fee schedule"}]}]},{"description":"US SCROTUM","code_information":[{"code":"76870","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":105.14,"maximum":1380.73,"gross_charge":1690,"discounted_cash":387.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":691.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":691.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":178.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":178.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":895.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1380.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US TRANSRECTAL","code_information":[{"code":"76872","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":250.69,"maximum":386.45,"gross_charge":473,"discounted_cash":108.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":386.45,"methodology":"fee schedule"}]}]},{"description":"US TRANSRECTAL","code_information":[{"code":"76872","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1042.98,"gross_charge":473,"discounted_cash":108.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1042.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1042.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":280.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":250.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":386.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US JOINT/FOCAL NONVAS LTD RT","code_information":[{"code":"76882","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":254.4,"maximum":392.16,"gross_charge":480,"discounted_cash":109.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":254.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.16,"methodology":"fee schedule"}]}]},{"description":"US JOINT/FOCAL NONVAS LTD RT","code_information":[{"code":"76882","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":66.52,"maximum":392.16,"gross_charge":480,"discounted_cash":109.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":321.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":321.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":254.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"US HIPS INFANT DYNAMIC","code_information":[{"code":"76885","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":581.41,"maximum":896.25,"gross_charge":1097,"discounted_cash":251.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":581.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":896.25,"methodology":"fee schedule"}]}]},{"description":"US HIPS INFANT DYNAMIC","code_information":[{"code":"76885","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":93.85,"maximum":896.25,"gross_charge":1097,"discounted_cash":251.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":776.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":776.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":310.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":232.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":232.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":581.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":896.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"US HIPS INFANT LIMITED STATIC","code_information":[{"code":"76886","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":190.8,"maximum":294.12,"gross_charge":360,"discounted_cash":82.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"}]}]},{"description":"US HIPS INFANT LIMITED STATIC","code_information":[{"code":"76886","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":93.85,"maximum":698.49,"gross_charge":360,"discounted_cash":82.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":698.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":698.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":178.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":178.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":311.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"minimum":8529.8,"maximum":29769.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27106,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27106,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11372.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8529.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8529.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26226.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21627.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29769.09,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12018.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12138.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12378.88,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12258.7,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12018.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12018.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12018.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12318.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12018.33,"methodology":"case rate"}]}]},{"description":"US GUIDE NDL PLACE(BX/ASP/INJ)","code_information":[{"code":"76942","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":596.25,"maximum":919.13,"gross_charge":1125,"discounted_cash":257.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":596.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":919.13,"methodology":"fee schedule"}]}]},{"description":"US GUIDE NDL PLACE(BX/ASP/INJ)","code_information":[{"code":"76942","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":61.15,"maximum":919.13,"gross_charge":1125,"discounted_cash":257.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":266.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":266.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":596.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":919.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.15,"methodology":"fee schedule"}]}]},{"description":"US GUIDE INTRAOP 0-1 HOUR","code_information":[{"code":"76998","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":422.94,"maximum":651.97,"gross_charge":798,"discounted_cash":182.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":422.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":651.97,"methodology":"fee schedule"}]}]},{"description":"US GUIDE INTRAOP 0-1 HOUR","code_information":[{"code":"76998","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":69.34,"maximum":651.97,"gross_charge":798,"discounted_cash":182.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":601.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":422.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":651.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.34,"methodology":"fee schedule"}]}]},{"description":"US GUIDE INTRAOP 1-2 HOUR","code_information":[{"code":"76998","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":563.92,"maximum":869.29,"gross_charge":1064,"discounted_cash":243.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":563.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":869.29,"methodology":"fee schedule"}]}]},{"description":"US GUIDE INTRAOP 1-2 HOUR","code_information":[{"code":"76998","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":69.34,"maximum":869.29,"gross_charge":1064,"discounted_cash":243.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":601.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":563.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":869.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.34,"methodology":"fee schedule"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"minimum":9002.23,"maximum":16221.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14770,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14770,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12002.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9002.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9002.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14291,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11785.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16221.36,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9594.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9689.98,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9881.86,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9785.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9594.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9594.03,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9594.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9833.89,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9594.03,"methodology":"case rate"}]}]},{"description":"XR FLUORO CVAD PLC/RPLC/REM","code_information":[{"code":"77001","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":445.2,"maximum":686.28,"gross_charge":840,"discounted_cash":192.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":445.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":686.28,"methodology":"fee schedule"}]}]},{"description":"XR FLUORO CVAD PLC/RPLC/REM","code_information":[{"code":"77001","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":103.35,"maximum":825.24,"gross_charge":840,"discounted_cash":192.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":825.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":825.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":234.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":234.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":445.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":686.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"}]}]},{"description":"XR FLUORO GUIDE NEEDLE PLACEMT","code_information":[{"code":"77002","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":601.02,"maximum":926.48,"gross_charge":1134,"discounted_cash":259.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":601.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":926.48,"methodology":"fee schedule"}]}]},{"description":"XR FLUORO GUIDE NEEDLE PLACEMT","code_information":[{"code":"77002","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":121.59,"maximum":926.48,"gross_charge":1134,"discounted_cash":259.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":873.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":259.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":259.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":601.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":926.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.59,"methodology":"fee schedule"}]}]},{"description":"CT FLUOR GUIDE NDL LOCAL SPINE","code_information":[{"code":"77003","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":212,"maximum":326.8,"gross_charge":400,"discounted_cash":91.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":212,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":326.8,"methodology":"fee schedule"}]}]},{"description":"CT FLUOR GUIDE NDL LOCAL SPINE","code_information":[{"code":"77003","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":110.5,"maximum":750.45,"gross_charge":400,"discounted_cash":91.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":750.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":750.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":295.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":221.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":221.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":212,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":326.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.5,"methodology":"fee schedule"}]}]},{"description":"DRUG AND ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE","code_information":[{"code":"7701","type":"APR-DRG"}],"standard_charges":[{"minimum":1525,"maximum":1525,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525,"methodology":"case rate"}]}]},{"description":"CT GUIDED NEEDLE PLACEMENT","code_information":[{"code":"77012","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":1751.12,"maximum":2699.37,"gross_charge":3304,"discounted_cash":756.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1751.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2699.37,"methodology":"fee schedule"}]}]},{"description":"CT GUIDED NEEDLE PLACEMENT","code_information":[{"code":"77012","type":"CPT"},{"code":"0359","type":"RC"}],"standard_charges":[{"minimum":146.27,"maximum":2699.37,"gross_charge":3304,"discounted_cash":756.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":226.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":170.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":170.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1334,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1751.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2699.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.27,"methodology":"fee schedule"}]}]},{"description":"DRUG AND ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE","code_information":[{"code":"7702","type":"APR-DRG"}],"standard_charges":[{"minimum":2383,"maximum":2383,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2383,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2383,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2383,"methodology":"case rate"}]}]},{"description":"DRUG AND ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE","code_information":[{"code":"7703","type":"APR-DRG"}],"standard_charges":[{"minimum":4276,"maximum":4276,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4276,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4276,"methodology":"case rate"}]}]},{"description":"DRUG AND ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE","code_information":[{"code":"7704","type":"APR-DRG"}],"standard_charges":[{"minimum":9293,"maximum":9293,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9293,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9293,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9293,"methodology":"case rate"}]}]},{"description":"CT BONE LENGTH STUDIES","code_information":[{"code":"77073","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":187.62,"maximum":289.22,"gross_charge":354,"discounted_cash":81.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.22,"methodology":"fee schedule"}]}]},{"description":"CT BONE LENGTH STUDIES","code_information":[{"code":"77073","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":47.56,"maximum":383.01,"gross_charge":354,"discounted_cash":81.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":311.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":95.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":95.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR BONE LENGTH STUDIES","code_information":[{"code":"77073","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":210.41,"maximum":324.35,"gross_charge":397,"discounted_cash":90.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":210.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.35,"methodology":"fee schedule"}]}]},{"description":"XR BONE LENGTH STUDIES","code_information":[{"code":"77073","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":47.56,"maximum":383.01,"gross_charge":397,"discounted_cash":90.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":311.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":95.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":95.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":210.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR BONE SURVEY LIMITED","code_information":[{"code":"77074","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":698.01,"maximum":1075.99,"gross_charge":1317,"discounted_cash":301.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":698.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1075.99,"methodology":"fee schedule"}]}]},{"description":"XR BONE SURVEY LIMITED","code_information":[{"code":"77074","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":1075.99,"gross_charge":1317,"discounted_cash":301.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":431.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":431.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":86.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":86.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":698.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1075.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR BONE SURVEY COMPLETE","code_information":[{"code":"77075","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1041.45,"maximum":1605.41,"gross_charge":1965,"discounted_cash":449.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1041.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1605.41,"methodology":"fee schedule"}]}]},{"description":"XR BONE SURVEY COMPLETE","code_information":[{"code":"77075","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":104.42,"maximum":1605.41,"gross_charge":1965,"discounted_cash":449.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":711.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":216.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":216.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1041.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1605.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"XR BONE SURVEY INFANT","code_information":[{"code":"77076","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1049.93,"maximum":1618.48,"gross_charge":1981,"discounted_cash":453.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1049.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1618.48,"methodology":"fee schedule"}]}]},{"description":"XR BONE SURVEY INFANT","code_information":[{"code":"77076","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":112.65,"maximum":1618.48,"gross_charge":1981,"discounted_cash":453.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":717.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":717.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":189.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1049.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1618.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":235.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"VACCINE ADMINISTRATION","code_information":[{"code":"771","type":"RC"}],"standard_charges":[{"minimum":95,"maximum":109,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":109,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":109,"methodology":"case rate"}]}]},{"description":"ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY","code_information":[{"code":"7721","type":"APR-DRG"}],"standard_charges":[{"minimum":3319,"maximum":3319,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3319,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3319,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3319,"methodology":"case rate"}]}]},{"description":"ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY","code_information":[{"code":"7722","type":"APR-DRG"}],"standard_charges":[{"minimum":4102,"maximum":4102,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4102,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4102,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4102,"methodology":"case rate"}]}]},{"description":"ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY","code_information":[{"code":"7723","type":"APR-DRG"}],"standard_charges":[{"minimum":5096,"maximum":5096,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5096,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5096,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5096,"methodology":"case rate"}]}]},{"description":"ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY","code_information":[{"code":"7724","type":"APR-DRG"}],"standard_charges":[{"minimum":15991,"maximum":15991,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15991,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15991,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15991,"methodology":"case rate"}]}]},{"description":"OPIOID ABUSE AND DEPENDENCE","code_information":[{"code":"7731","type":"APR-DRG"}],"standard_charges":[{"minimum":1738,"maximum":1738,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1738,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1738,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1738,"methodology":"case rate"}]}]},{"description":"OPIOID ABUSE AND DEPENDENCE","code_information":[{"code":"7732","type":"APR-DRG"}],"standard_charges":[{"minimum":2444,"maximum":2444,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2444,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2444,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2444,"methodology":"case rate"}]}]},{"description":"OPIOID ABUSE AND DEPENDENCE","code_information":[{"code":"7733","type":"APR-DRG"}],"standard_charges":[{"minimum":4640,"maximum":4640,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4640,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4640,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4640,"methodology":"case rate"}]}]},{"description":"OPIOID ABUSE AND DEPENDENCE","code_information":[{"code":"7734","type":"APR-DRG"}],"standard_charges":[{"minimum":11938,"maximum":11938,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11938,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11938,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11938,"methodology":"case rate"}]}]},{"description":"COCAINE ABUSE AND DEPENDENCE","code_information":[{"code":"7741","type":"APR-DRG"}],"standard_charges":[{"minimum":2213,"maximum":2213,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213,"methodology":"case rate"}]}]},{"description":"COCAINE ABUSE AND DEPENDENCE","code_information":[{"code":"7742","type":"APR-DRG"}],"standard_charges":[{"minimum":2459,"maximum":2459,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2459,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2459,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2459,"methodology":"case rate"}]}]},{"description":"COCAINE ABUSE AND DEPENDENCE","code_information":[{"code":"7743","type":"APR-DRG"}],"standard_charges":[{"minimum":4382,"maximum":4382,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4382,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4382,"methodology":"case rate"}]}]},{"description":"COCAINE ABUSE AND DEPENDENCE","code_information":[{"code":"7744","type":"APR-DRG"}],"standard_charges":[{"minimum":12226,"maximum":12226,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12226,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12226,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12226,"methodology":"case rate"}]}]},{"description":"ALCOHOL ABUSE AND DEPENDENCE","code_information":[{"code":"7751","type":"APR-DRG"}],"standard_charges":[{"minimum":2333,"maximum":2333,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2333,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2333,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2333,"methodology":"case rate"}]}]},{"description":"ALCOHOL ABUSE AND DEPENDENCE","code_information":[{"code":"7752","type":"APR-DRG"}],"standard_charges":[{"minimum":3287,"maximum":3287,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3287,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3287,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3287,"methodology":"case rate"}]}]},{"description":"ALCOHOL ABUSE AND DEPENDENCE","code_information":[{"code":"7753","type":"APR-DRG"}],"standard_charges":[{"minimum":5877,"maximum":5877,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5877,"methodology":"case rate"}]}]},{"description":"ALCOHOL ABUSE AND DEPENDENCE","code_information":[{"code":"7754","type":"APR-DRG"}],"standard_charges":[{"minimum":14788,"maximum":14788,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14788,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14788,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14788,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"minimum":6790.81,"maximum":14645.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13335,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13335,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10338.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7753.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7753.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12902.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10639.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14645.23,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.81,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6858.72,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6994.54,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6926.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.81,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6960.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6790.81,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE","code_information":[{"code":"7761","type":"APR-DRG"}],"standard_charges":[{"minimum":2261,"maximum":2261,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2261,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2261,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2261,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE","code_information":[{"code":"7762","type":"APR-DRG"}],"standard_charges":[{"minimum":2686,"maximum":2686,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2686,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2686,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2686,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE","code_information":[{"code":"7763","type":"APR-DRG"}],"standard_charges":[{"minimum":5099,"maximum":5099,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5099,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5099,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5099,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE","code_information":[{"code":"7764","type":"APR-DRG"}],"standard_charges":[{"minimum":10131,"maximum":10131,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10131,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10131,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10131,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"minimum":8502.13,"maximum":26971.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21448,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21448,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26971.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20229.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20229.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20752.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17113.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23555.33,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8502.13,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8587.16,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8757.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8672.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8502.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8502.13,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8502.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8714.69,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8502.13,"methodology":"case rate"}]}]},{"description":"NM HEPATOBILIARY SYSTEM","code_information":[{"code":"78226","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":1221.65,"maximum":1883.19,"gross_charge":2305,"discounted_cash":527.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1221.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1883.19,"methodology":"fee schedule"}]}]},{"description":"NM HEPATOBILIARY SYSTEM","code_information":[{"code":"78226","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":310.77,"maximum":2657.03,"gross_charge":2305,"discounted_cash":527.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2657.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2657.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1162.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":872.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":872.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1392.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1392.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1221.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1883.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":432.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":441.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":436.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":438.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"}]}]},{"description":"NM HEPATOBILIARY SYS W/RX","code_information":[{"code":"78227","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":1673.74,"maximum":2580.09,"gross_charge":3158,"discounted_cash":723.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1673.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2580.09,"methodology":"fee schedule"}]}]},{"description":"NM HEPATOBILIARY SYS W/RX","code_information":[{"code":"78227","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":416.62,"maximum":3618.42,"gross_charge":3158,"discounted_cash":723.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3618.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3618.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1580.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1185.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1185.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1673.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2580.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":579.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":590.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":585.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":588.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"}]}]},{"description":"NM GASTRIC EMPTYING","code_information":[{"code":"78264","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":2056.93,"maximum":3170.78,"gross_charge":3881,"discounted_cash":888.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2056.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3170.78,"methodology":"fee schedule"}]}]},{"description":"NM GASTRIC EMPTYING","code_information":[{"code":"78264","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":316.13,"maximum":3170.78,"gross_charge":3881,"discounted_cash":888.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2683.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2683.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":884.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":884.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1392.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1392.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2056.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3170.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":432.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":441.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":436.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":438.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITH MCC","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"minimum":10813,"maximum":44247.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40290,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40290,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18914.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14186.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14186.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44247.22,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15518.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15673.48,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15983.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15828.66,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15518.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15518.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15518.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15906.25,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15518.29,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITH CC","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"minimum":9648.16,"maximum":21562.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19634,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19634,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16640.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12480.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12480.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21562.47,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9648.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9744.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9937.61,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9841.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9648.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9648.16,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9648.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9889.37,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9648.16,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"minimum":8028.09,"maximum":21160.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16125,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16125,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21160.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15870.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15870.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17708.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8028.09,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8108.38,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8268.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8188.66,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8028.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8028.09,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8028.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8228.8,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8028.09,"methodology":"case rate"}]}]},{"description":"NM PULM PERFUSION PARTICULATE","code_information":[{"code":"78580","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":1005.94,"maximum":1550.67,"gross_charge":1898,"discounted_cash":434.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1005.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1550.67,"methodology":"fee schedule"}]}]},{"description":"NM PULM PERFUSION PARTICULATE","code_information":[{"code":"78580","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":227.09,"maximum":1841.57,"gross_charge":1898,"discounted_cash":434.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1841.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1841.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":812.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":609.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":609.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1392.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1392.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1005.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1550.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":884.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":432.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":441.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":436.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":438.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":428.28,"methodology":"fee schedule"}]}]},{"description":"NM PULM VENT PERFUSION IMAGING","code_information":[{"code":"78582","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":1487.71,"maximum":2293.32,"gross_charge":2807,"discounted_cash":642.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1487.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2293.32,"methodology":"fee schedule"}]}]},{"description":"NM PULM VENT PERFUSION IMAGING","code_information":[{"code":"78582","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":317.92,"maximum":2578.98,"gross_charge":2807,"discounted_cash":642.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2578.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2578.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1124.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":843.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":843.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1487.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2293.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":579.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":590.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":585.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":588.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITH MCC","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":10813,"maximum":35370.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32206,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32206,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17073.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12805.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12805.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35370.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13769.09,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13906.79,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14182.17,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14044.48,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13769.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13769.09,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13769.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14113.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13769.09,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITH CC","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":9484.22,"maximum":21568.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19639,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19639,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15134.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11351.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11351.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21568.66,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9484.22,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9579.07,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9768.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9673.91,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9484.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9484.22,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9484.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9721.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9484.22,"methodology":"case rate"}]}]},{"description":"NM KIDNEY W FLOW/FUNCT SNGL W","code_information":[{"code":"78708","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":1630.28,"maximum":2513.1,"gross_charge":3076,"discounted_cash":704.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1630.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2513.1,"methodology":"fee schedule"}]}]},{"description":"NM KIDNEY W FLOW/FUNCT SNGL W","code_information":[{"code":"78708","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":183.82,"maximum":2513.1,"gross_charge":3076,"discounted_cash":704.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1142.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1142.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":410.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":410.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1630.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2513.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1158.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":579.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":590.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":585.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":588.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":573.7,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":8269.36,"maximum":24919.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17022,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17022,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24919.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18689.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18689.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18694.9,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8269.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8352.06,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8517.45,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8434.75,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8269.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8269.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8269.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8476.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8269.36,"methodology":"case rate"}]}]},{"description":"NEONATES DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"minimum":15212.84,"maximum":136183.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1457,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1457,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136183.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":102139.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":102139.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30715.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25329.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34864.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15212.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15364.97,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15669.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15517.1,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15212.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15212.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15212.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15593.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15212.84,"methodology":"case rate"}]}]},{"description":"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME NEONATE","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"minimum":37740.34,"maximum":114970.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4365,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4365,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50319.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37740.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37740.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":101289.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":83528.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":114970.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":47244.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":47717,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":48661.89,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":48189.45,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":47244.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":47244.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":47244.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":48425.67,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":47244.55,"methodology":"case rate"}]}]},{"description":"LITHOTRIPSY ESWL UNI","code_information":[{"code":"7901000687","type":"CDM"},{"code":"0790","type":"RC"}],"standard_charges":[{"minimum":21064.32,"maximum":32470.85,"gross_charge":39744,"discounted_cash":9101.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21064.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32470.85,"methodology":"fee schedule"}]}]},{"description":"LITHOTRIPSY ESWL UNI","code_information":[{"code":"7901000687","type":"CDM"},{"code":"0790","type":"RC"}],"standard_charges":[{"minimum":9468,"maximum":32470.85,"gross_charge":39744,"discounted_cash":9101.38,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9468,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9468,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21064.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32470.85,"methodology":"fee schedule"}]}]},{"description":"LITHOTRIPSY ESWL BIL","code_information":[{"code":"7901000688","type":"CDM"},{"code":"0790","type":"RC"}],"standard_charges":[{"minimum":31596.48,"maximum":48706.28,"gross_charge":59616,"discounted_cash":13652.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31596.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48706.28,"methodology":"fee schedule"}]}]},{"description":"LITHOTRIPSY ESWL BIL","code_information":[{"code":"7901000688","type":"CDM"},{"code":"0790","type":"RC"}],"standard_charges":[{"minimum":9468,"maximum":48706.28,"gross_charge":59616,"discounted_cash":13652.07,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9468,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9468,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31596.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48706.28,"methodology":"fee schedule"}]}]},{"description":"PREMATURITY WITH MAJOR PROBLEMS","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"minimum":15712.38,"maximum":78521.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2040,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20949.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15712.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15712.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":69177.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":57047.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":78521.9,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32668.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32995.27,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33648.64,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33321.96,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32668.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32668.58,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32668.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33485.3,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32668.58,"methodology":"case rate"}]}]},{"description":"PREMATURITY WITHOUT MAJOR PROBLEMS","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"minimum":13617.57,"maximum":47376.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1457,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1457,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18156.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13617.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13617.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":41738.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34419.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47376.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20216.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20419.05,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20823.39,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20621.22,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20216.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20216.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20216.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20722.31,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20216.88,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7921","type":"APR-DRG"}],"standard_charges":[{"minimum":9226,"maximum":9226,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9226,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9226,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9226,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7922","type":"APR-DRG"}],"standard_charges":[{"minimum":11451,"maximum":11451,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11451,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11451,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11451,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7923","type":"APR-DRG"}],"standard_charges":[{"minimum":16839,"maximum":16839,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16839,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16839,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16839,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7924","type":"APR-DRG"}],"standard_charges":[{"minimum":33913,"maximum":33913,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33913,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33913,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33913,"methodology":"case rate"}]}]},{"description":"FULL TERM NEONATE WITH MAJOR PROBLEMS","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":5238.32,"maximum":80657.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2040,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2040,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6984.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5238.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5238.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":71058.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":58598.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":80657.11,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33523.86,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":33859.1,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34529.58,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34194.34,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33523.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33523.86,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33523.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34361.96,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33523.86,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7931","type":"APR-DRG"}],"standard_charges":[{"minimum":5935,"maximum":5935,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5935,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5935,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5935,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7932","type":"APR-DRG"}],"standard_charges":[{"minimum":8427,"maximum":8427,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8427,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8427,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8427,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7933","type":"APR-DRG"}],"standard_charges":[{"minimum":13453,"maximum":13453,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13453,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13453,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13453,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7934","type":"APR-DRG"}],"standard_charges":[{"minimum":26923,"maximum":26923,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26923,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26923,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26923,"methodology":"case rate"}]}]},{"description":"NEONATE WITH OTHER SIGNIFICANT PROBLEMS","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":1695.06,"maximum":28547.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1457,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1457,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2260.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1695.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1695.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25150.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20740.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28547.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12688.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12815.67,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13069.45,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12942.56,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12688.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12688.78,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12688.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13006,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12688.78,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7941","type":"APR-DRG"}],"standard_charges":[{"minimum":5315,"maximum":5315,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5315,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5315,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5315,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7942","type":"APR-DRG"}],"standard_charges":[{"minimum":6390,"maximum":6390,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6390,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6390,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6390,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7943","type":"APR-DRG"}],"standard_charges":[{"minimum":10482,"maximum":10482,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10482,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10482,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10482,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7944","type":"APR-DRG"}],"standard_charges":[{"minimum":16797,"maximum":16797,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16797,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16797,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16797,"methodology":"case rate"}]}]},{"description":"NORMAL NEWBORN","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":2807.25,"maximum":18478.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1236,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1236,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18478.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13858.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13858.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":3404.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2807.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3863.99,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2818.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2846.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2902.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2874.73,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2818.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2818.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2818.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2888.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2818.36,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"minimum":5937,"maximum":40688.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37049,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37049,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11774.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8830.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8830.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":7081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5937,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40688.54,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11145.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11256.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11479.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11368.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11145.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11145.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11145.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11423.91,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11145.27,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"minimum":5937,"maximum":17799.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16207,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16207,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10383,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7787.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7787.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":7081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5937,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17799.56,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8848.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9023.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8935.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8979.43,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"minimum":5937,"maximum":70850.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16207,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16207,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70850.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53138.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53138.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":7081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5937,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17799.56,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8848.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9023.23,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8935.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8979.43,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8760.41,"methodology":"case rate"}]}]},{"description":"SPLENIC PROCEDURES WITH MCC","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"minimum":37140.71,"maximum":102000.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92878,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92878,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49519.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37140.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37140.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":89862.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74105.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":102000.9,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38042.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38422.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39183.53,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38803.11,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38042.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38042.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38042.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38993.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38042.26,"methodology":"case rate"}]}]},{"description":"SPLENIC PROCEDURES WITH CC","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"minimum":23805.77,"maximum":58630.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53386,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53386,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41691.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31269.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31269.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":51653.35,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":42595.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":58630.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23805.77,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24043.83,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24519.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24281.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23805.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23805.77,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23805.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24400.92,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23805.77,"methodology":"case rate"}]}]},{"description":"METABOLIC PANEL IONIZED CA","code_information":[{"code":"80047","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":417.64,"maximum":643.8,"gross_charge":788,"discounted_cash":180.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":643.8,"methodology":"fee schedule"}]}]},{"description":"METABOLIC PANEL IONIZED CA","code_information":[{"code":"80047","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.23,"maximum":643.8,"gross_charge":788,"discounted_cash":180.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":643.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"BASIC METABOLIC PANEL","code_information":[{"code":"80048","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":121.37,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"}]}]},{"description":"BASIC METABOLIC PANEL","code_information":[{"code":"80048","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.07,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"}]}]},{"description":"ELECTROLYTE PANEL","code_information":[{"code":"80051","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":85.33,"maximum":131.54,"gross_charge":161,"discounted_cash":36.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":131.54,"methodology":"fee schedule"}]}]},{"description":"ELECTROLYTE PANEL","code_information":[{"code":"80051","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.2,"maximum":131.54,"gross_charge":161,"discounted_cash":36.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":131.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"}]}]},{"description":"ELECTROLYTE PANEL QW","code_information":[{"code":"80051","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.84,"maximum":22.88,"gross_charge":28,"discounted_cash":6.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"}]}]},{"description":"ELECTROLYTE PANEL QW","code_information":[{"code":"80051","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.2,"maximum":34.14,"gross_charge":28,"discounted_cash":6.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"}]}]},{"description":"COMPREHENSIVE METABOLIC PANEL","code_information":[{"code":"80053","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":310.05,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"}]}]},{"description":"COMPREHENSIVE METABOLIC PANEL","code_information":[{"code":"80053","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.33,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"}]}]},{"description":"LIPID PANEL","code_information":[{"code":"80061","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":281.43,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"}]}]},{"description":"LIPID PANEL","code_information":[{"code":"80061","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.03,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-LIPID PANEL 80503B","code_information":[{"code":"80061","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.66,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-LIPID PANEL 80503B","code_information":[{"code":"80061","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.03,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"}]}]},{"description":"RENAL FUNCTION PANEL","code_information":[{"code":"80069","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":205.64,"maximum":317,"gross_charge":388,"discounted_cash":88.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":205.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317,"methodology":"fee schedule"}]}]},{"description":"RENAL FUNCTION PANEL","code_information":[{"code":"80069","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.2,"maximum":317,"gross_charge":388,"discounted_cash":88.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":205.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"}]}]},{"description":"ACUTE HEPATITIS PANEL","code_information":[{"code":"80074","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":603.14,"maximum":929.75,"gross_charge":1138,"discounted_cash":260.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":603.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":929.75,"methodology":"fee schedule"}]}]},{"description":"ACUTE HEPATITIS PANEL","code_information":[{"code":"80074","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":28.57,"maximum":929.75,"gross_charge":1138,"discounted_cash":260.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":98.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":98.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":603.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":929.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":49.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":48.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"}]}]},{"description":"HEPATIC FUNCTION PANEL","code_information":[{"code":"80076","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":198.75,"maximum":306.38,"gross_charge":375,"discounted_cash":85.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":198.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306.38,"methodology":"fee schedule"}]}]},{"description":"HEPATIC FUNCTION PANEL","code_information":[{"code":"80076","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.9,"maximum":306.38,"gross_charge":375,"discounted_cash":85.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":198.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"}]}]},{"description":"SPLENIC PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"minimum":13968.6,"maximum":58297.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35188,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35188,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58297.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43723.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43723.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34045.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28075.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38644.11,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13968.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14108.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14387.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14247.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13968.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13968.6,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13968.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14317.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13968.6,"methodology":"case rate"}]}]},{"description":"AMIKACIN","code_information":[{"code":"80150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":118.72,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN","code_information":[{"code":"80150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.04,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMIODARONE METABOL 90161","code_information":[{"code":"80151","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":81.62,"maximum":125.82,"gross_charge":154,"discounted_cash":35.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMIODARONE METABOL 90161","code_information":[{"code":"80151","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.18,"maximum":125.82,"gross_charge":154,"discounted_cash":35.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE TOTAL","code_information":[{"code":"80156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":170.13,"maximum":262.26,"gross_charge":321,"discounted_cash":73.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":170.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":262.26,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE TOTAL","code_information":[{"code":"80156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.74,"maximum":262.26,"gross_charge":321,"discounted_cash":73.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":170.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":262.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARBAMAZEPINE TOT 92211A","code_information":[{"code":"80156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":41.34,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARBAMAZEPINE TOT 92211A","code_information":[{"code":"80156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.74,"maximum":70.93,"gross_charge":78,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE","code_information":[{"code":"80158","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":123.49,"maximum":190.37,"gross_charge":233,"discounted_cash":53.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":123.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.37,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE","code_information":[{"code":"80158","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.83,"maximum":190.37,"gross_charge":233,"discounted_cash":53.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":123.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-CLOZAP/MET SP QN 2013433","code_information":[{"code":"80159","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":217.3,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-CLOZAP/MET SP QN 2013433","code_information":[{"code":"80159","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.09,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":58.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARBAM -10 11 EPOX92211B","code_information":[{"code":"80161","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":41.34,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARBAM -10 11 EPOX92211B","code_information":[{"code":"80161","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.18,"maximum":90.75,"gross_charge":78,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN TOTAL","code_information":[{"code":"80162","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":105.47,"maximum":162.59,"gross_charge":199,"discounted_cash":45.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.59,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN TOTAL","code_information":[{"code":"80162","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.96,"maximum":162.59,"gross_charge":199,"discounted_cash":45.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"}]}]},{"description":"VALPROIC ACID TOTAL","code_information":[{"code":"80164","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":105.47,"maximum":162.59,"gross_charge":199,"discounted_cash":45.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.59,"methodology":"fee schedule"}]}]},{"description":"VALPROIC ACID TOTAL","code_information":[{"code":"80164","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.12,"maximum":162.59,"gross_charge":199,"discounted_cash":45.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"}]}]},{"description":"RL-A-FELBAMATE 94030","code_information":[{"code":"80167","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":40.81,"maximum":62.91,"gross_charge":77,"discounted_cash":17.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-FELBAMATE 94030","code_information":[{"code":"80167","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.18,"maximum":90.75,"gross_charge":77,"discounted_cash":17.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-ETHOSUXIMIDE SP 2010358","code_information":[{"code":"80168","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.45,"maximum":53.11,"gross_charge":65,"discounted_cash":14.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-ETHOSUXIMIDE SP 2010358","code_information":[{"code":"80168","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.8,"maximum":79.51,"gross_charge":65,"discounted_cash":14.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-EVEROLIMUS SPECTROM 92118","code_information":[{"code":"80169","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":39.22,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-EVEROLIMUS SPECTROM 92118","code_information":[{"code":"80169","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.23,"maximum":66.85,"gross_charge":74,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN","code_information":[{"code":"80170","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN","code_information":[{"code":"80170","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.82,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-HALOPERIDOL 99640","code_information":[{"code":"80173","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.15,"maximum":44.94,"gross_charge":55,"discounted_cash":12.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-HALOPERIDOL 99640","code_information":[{"code":"80173","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":76.79,"gross_charge":55,"discounted_cash":12.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-LAMOTRIGINE 90177","code_information":[{"code":"80175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":79.5,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-LAMOTRIGINE 90177","code_information":[{"code":"80175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-KEPPRA LEVETIRACETAM98627","code_information":[{"code":"80177","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":79.5,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-KEPPRA LEVETIRACETAM98627","code_information":[{"code":"80177","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"LITHIUM","code_information":[{"code":"80178","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.89,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"}]}]},{"description":"LITHIUM","code_information":[{"code":"80178","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.96,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOPHENOLIC MET 2010359","code_information":[{"code":"80180","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":75.79,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOPHENOLIC MET 2010359","code_information":[{"code":"80180","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.83,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-FLECAINIDE SP 90003","code_information":[{"code":"80181","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-FLECAINIDE SP 90003","code_information":[{"code":"80181","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.18,"maximum":90.75,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL","code_information":[{"code":"80184","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":80.56,"maximum":124.19,"gross_charge":152,"discounted_cash":34.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.19,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL","code_information":[{"code":"80184","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.18,"maximum":124.19,"gross_charge":152,"discounted_cash":34.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHENOBARBITAL 90202A","code_information":[{"code":"80184","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.98,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHENOBARBITAL 90202A","code_information":[{"code":"80184","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.18,"maximum":74.43,"gross_charge":66,"discounted_cash":15.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN TOTAL","code_information":[{"code":"80185","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":83.74,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN TOTAL","code_information":[{"code":"80185","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHENYTOIN TOTAL 90141A","code_information":[{"code":"80185","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHENYTOIN TOTAL 90141A","code_information":[{"code":"80185","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHENYTOIN FREE 90141B","code_information":[{"code":"80186","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":45.05,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHENYTOIN FREE 90141B","code_information":[{"code":"80186","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.25,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-POSACONAZOL QUANT 2001739","code_information":[{"code":"80187","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":337.61,"maximum":520.43,"gross_charge":637,"discounted_cash":145.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":337.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":520.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-POSACONAZOL QUANT 2001739","code_information":[{"code":"80187","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.26,"maximum":520.43,"gross_charge":637,"discounted_cash":145.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":79.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":337.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":520.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-PRIMIDONE 90202B","code_information":[{"code":"80188","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.88,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-PRIMIDONE 90202B","code_information":[{"code":"80188","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.95,"maximum":80.73,"gross_charge":96,"discounted_cash":21.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-ITRACONAZOLE QN 98519","code_information":[{"code":"80189","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-ITRACONAZOLE QN 98519","code_information":[{"code":"80189","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.26,"maximum":131.9,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":79.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-SIROLIMUS SPECTROM 98467","code_information":[{"code":"80195","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":67.84,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-SIROLIMUS SPECTROM 98467","code_information":[{"code":"80195","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.23,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS","code_information":[{"code":"80197","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":81.09,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS","code_information":[{"code":"80197","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.23,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"minimum":28574.57,"maximum":65034.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59217,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59217,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38098.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28574.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28574.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":57294.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47248.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65034.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28994.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29284.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29864.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29574.53,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28994.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28994.63,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28994.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29719.5,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28994.63,"methodology":"case rate"}]}]},{"description":"TOBRAMYCIN","code_information":[{"code":"80200","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":127.2,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN","code_information":[{"code":"80200","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.67,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-TOPIRAMATE 70390","code_information":[{"code":"80201","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-TOPIRAMATE 70390","code_information":[{"code":"80201","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.15,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":34.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN","code_information":[{"code":"80202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.73,"maximum":33.5,"gross_charge":41,"discounted_cash":9.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN","code_information":[{"code":"80202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.12,"maximum":65.92,"gross_charge":41,"discounted_cash":9.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZONISAMIDE 97908","code_information":[{"code":"80203","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":94.34,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZONISAMIDE 97908","code_information":[{"code":"80203","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHOTREXATE SENS 2005405","code_information":[{"code":"80204","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":81.62,"maximum":125.82,"gross_charge":154,"discounted_cash":35.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHOTREXATE SENS 2005405","code_information":[{"code":"80204","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.14,"maximum":187.73,"gross_charge":154,"discounted_cash":35.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":112.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-VORICONAZOL QUANT 2001737","code_information":[{"code":"80285","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.69,"maximum":59.65,"gross_charge":73,"discounted_cash":16.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-VORICONAZOL QUANT 2001737","code_information":[{"code":"80285","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.26,"maximum":131.9,"gross_charge":73,"discounted_cash":16.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":79.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-DEXA TMS LC-MS/MS 2003248","code_information":[{"code":"80299","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":187.09,"maximum":288.41,"gross_charge":353,"discounted_cash":80.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":288.41,"methodology":"fee schedule"}]}]},{"description":"RL-A-DEXA TMS LC-MS/MS 2003248","code_information":[{"code":"80299","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.18,"maximum":288.41,"gross_charge":353,"discounted_cash":80.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":288.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"THERAPEUTIC DRUG OTHER QNT","code_information":[{"code":"80299","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"THERAPEUTIC DRUG OTHER QNT","code_information":[{"code":"80299","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.18,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"minimum":15038.07,"maximum":36754.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33467,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33467,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30785.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23089.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23089.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32380.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26702.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36754.4,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15038.07,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15188.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15489.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15338.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15038.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15038.07,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15038.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15414.03,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15038.07,"methodology":"case rate"}]}]},{"description":"DRG SCRN PRESUMP INSTR OPTICAL","code_information":[{"code":"80306","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":72.61,"maximum":111.93,"gross_charge":137,"discounted_cash":31.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"}]}]},{"description":"DRG SCRN PRESUMP INSTR OPTICAL","code_information":[{"code":"80306","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.28,"maximum":111.93,"gross_charge":137,"discounted_cash":31.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"}]}]},{"description":"DRUG SCREEN PRESUMP CHEM ANALY","code_information":[{"code":"80307","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":358.81,"maximum":553.11,"gross_charge":677,"discounted_cash":155.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":358.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":553.11,"methodology":"fee schedule"}]}]},{"description":"DRUG SCREEN PRESUMP CHEM ANALY","code_information":[{"code":"80307","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.28,"maximum":553.11,"gross_charge":677,"discounted_cash":155.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":302.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":302.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":128.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":128.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":181.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":358.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":553.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":63.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMPHET UR WRFLX 2012209","code_information":[{"code":"80307","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":137.27,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMPHET UR WRFLX 2012209","code_information":[{"code":"80307","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.28,"maximum":302.45,"gross_charge":259,"discounted_cash":59.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":302.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":302.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":128.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":128.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":181.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":63.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-PAIN SCRN RFLX QN 2012312","code_information":[{"code":"80307","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-PAIN SCRN RFLX QN 2012312","code_information":[{"code":"80307","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.28,"maximum":302.45,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":302.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":302.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":128.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":128.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":181.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":63.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"minimum":9822.93,"maximum":28110.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25596,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25596,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14138.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10603.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10603.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24765.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20422.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28110.43,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9822.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9921.16,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10117.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10019.39,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9822.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9822.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9822.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10068.51,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9822.93,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"minimum":5937,"maximum":21469.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19549,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19549,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8669.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6502.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6502.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":7081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5937,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21469.64,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.85,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9080.76,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9260.58,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9170.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.85,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9215.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8990.85,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":5464.16,"maximum":14630.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13322,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13322,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7285.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5464.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5464.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":7081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5937,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14630.79,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6868.91,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6937.6,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.98,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7006.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6868.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6868.91,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6868.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7040.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6868.91,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"minimum":5937,"maximum":39157.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11774,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11774,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39157.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29368.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29368.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":7081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5937,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12930.88,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6201.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6263.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6387.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6325.59,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6201.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6201.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6201.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6356.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6201.55,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"minimum":18984.23,"maximum":43933.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40004,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40004,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29134.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21851.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21851.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38705.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31918.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43933.64,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18984.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19174.08,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19553.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19363.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18984.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18984.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18984.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19458.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18984.23,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"minimum":10850.64,"maximum":26009.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22840,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22840,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26009.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19507.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19507.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22098.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18223.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25084.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10850.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10959.15,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11176.16,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11067.66,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10850.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10850.64,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10850.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11121.91,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10850.64,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"minimum":8633.59,"maximum":22178.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17571,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17571,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22178.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16633.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16633.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17000.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14019.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19297.3,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8633.59,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8719.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8892.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8806.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8633.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8633.59,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8633.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8849.43,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8633.59,"methodology":"case rate"}]}]},{"description":"URINALYSIS AUTO W MICRO","code_information":[{"code":"81001","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":51.94,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"}]}]},{"description":"URINALYSIS AUTO W MICRO","code_information":[{"code":"81001","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":1.9,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"}]}]},{"description":"URINALYSIS NONAUTO WO MICRO","code_information":[{"code":"81002","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":13.78,"maximum":21.25,"gross_charge":26,"discounted_cash":5.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"}]}]},{"description":"URINALYSIS NONAUTO WO MICRO","code_information":[{"code":"81002","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":2.08,"maximum":21.25,"gross_charge":26,"discounted_cash":5.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"}]}]},{"description":"URINALYSIS AUTO WO MICRO","code_information":[{"code":"81003","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"URINALYSIS AUTO WO MICRO","code_information":[{"code":"81003","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":1.35,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"}]}]},{"description":"URINALYSIS QUAL/SEMIQUANT","code_information":[{"code":"81005","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":89.04,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"}]}]},{"description":"URINALYSIS QUAL/SEMIQUANT","code_information":[{"code":"81005","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":1.3,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"}]}]},{"description":"HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION","code_information":[{"code":"8101","type":"APR-DRG"}],"standard_charges":[{"minimum":3275,"maximum":3275,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3275,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3275,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3275,"methodology":"case rate"}]}]},{"description":"HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION","code_information":[{"code":"8102","type":"APR-DRG"}],"standard_charges":[{"minimum":4332,"maximum":4332,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4332,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4332,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4332,"methodology":"case rate"}]}]},{"description":"URINE PREGNANCY VISUAL","code_information":[{"code":"81025","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":192.92,"maximum":297.39,"gross_charge":364,"discounted_cash":83.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":192.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":297.39,"methodology":"fee schedule"}]}]},{"description":"URINE PREGNANCY VISUAL","code_information":[{"code":"81025","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":5.16,"maximum":297.39,"gross_charge":364,"discounted_cash":83.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":192.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":297.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"}]}]},{"description":"HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION","code_information":[{"code":"8103","type":"APR-DRG"}],"standard_charges":[{"minimum":6854,"maximum":6854,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6854,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6854,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6854,"methodology":"case rate"}]}]},{"description":"HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION","code_information":[{"code":"8104","type":"APR-DRG"}],"standard_charges":[{"minimum":13680,"maximum":13680,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13680,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13680,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13680,"methodology":"case rate"}]}]},{"description":"URINE VOLUME MEASURE","code_information":[{"code":"81050","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":7.42,"maximum":11.44,"gross_charge":14,"discounted_cash":3.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"}]}]},{"description":"URINE VOLUME MEASURE","code_information":[{"code":"81050","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":2.18,"maximum":17.75,"gross_charge":14,"discounted_cash":3.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"}]}]},{"description":"RED BLOOD CELL DISORDERS WITH MCC","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"minimum":12152.88,"maximum":27650.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25177,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25177,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17246.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12934.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12934.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24359.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20088.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27650.38,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12152.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12274.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12517.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12395.94,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12152.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12152.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12152.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12456.71,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12152.88,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS","code_information":[{"code":"8111","type":"APR-DRG"}],"standard_charges":[{"minimum":2197,"maximum":2197,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2197,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS","code_information":[{"code":"8112","type":"APR-DRG"}],"standard_charges":[{"minimum":3270,"maximum":3270,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3270,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3270,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS","code_information":[{"code":"8113","type":"APR-DRG"}],"standard_charges":[{"minimum":6236,"maximum":6236,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6236,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6236,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6236,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS","code_information":[{"code":"8114","type":"APR-DRG"}],"standard_charges":[{"minimum":12503,"maximum":12503,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12503,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12503,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12503,"methodology":"case rate"}]}]},{"description":"RED BLOOD CELL DISORDERS WITHOUT MCC","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":8410.1,"maximum":24438.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16356,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16356,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24438.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18328.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18328.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15824.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13050.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17962.54,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8410.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8494.21,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8662.41,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8578.31,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8410.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8410.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8410.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8620.36,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8410.1,"methodology":"case rate"}]}]},{"description":"APC FULL GENE SEQUENCE","code_information":[{"code":"81201","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":374.71,"maximum":577.62,"gross_charge":707,"discounted_cash":161.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":374.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":577.62,"methodology":"fee schedule"}]}]},{"description":"APC FULL GENE SEQUENCE","code_information":[{"code":"81201","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":374.71,"maximum":3796.07,"gross_charge":707,"discounted_cash":161.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3796.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3796.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2443.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1832.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1832.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2281.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2281.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":374.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":577.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":468,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":468,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":468,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":707,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":714.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":728.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":721.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":707,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":707,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":707,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":724.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":707,"methodology":"fee schedule"}]}]},{"description":"RL-A-BCR-ABL1 MAJOR 3005839A","code_information":[{"code":"81206","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":88.33,"maximum":136.17,"gross_charge":166.66,"discounted_cash":38.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-BCR-ABL1 MAJOR 3005839A","code_information":[{"code":"81206","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":88.33,"maximum":797.93,"gross_charge":166.66,"discounted_cash":38.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":385.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":385.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":479.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":165.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":168.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":167.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-QUAN BCR ABL1 MAJ 3005840","code_information":[{"code":"81206","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":517.28,"maximum":797.4,"gross_charge":976,"discounted_cash":223.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":517.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":797.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-QUAN BCR ABL1 MAJ 3005840","code_information":[{"code":"81206","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":98.37,"maximum":797.93,"gross_charge":976,"discounted_cash":223.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":385.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":385.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":479.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":517.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":797.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":165.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":168.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":167.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-BCR-ABL1 MINOR 3005839B","code_information":[{"code":"81207","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":88.33,"maximum":136.17,"gross_charge":166.66,"discounted_cash":38.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-BCR-ABL1 MINOR 3005839B","code_information":[{"code":"81207","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":86.9,"maximum":704.89,"gross_charge":166.66,"discounted_cash":38.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":704.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":704.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":453.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":340.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":340.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":423.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":146.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":149.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":147.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":148.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":144.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-BCR-ABL1 QUAL/QNT3005839C","code_information":[{"code":"81208","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":88.35,"maximum":136.18,"gross_charge":166.68,"discounted_cash":38.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-BCR-ABL1 QUAL/QNT3005839C","code_information":[{"code":"81208","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":88.35,"maximum":1044.49,"gross_charge":166.68,"discounted_cash":38.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1044.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1044.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":672.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":504.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":504.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":627.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":627.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":128.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":128.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.68,"methodology":"fee schedule"}]}]},{"description":"POISONING OF MEDICINAL AGENTS","code_information":[{"code":"8121","type":"APR-DRG"}],"standard_charges":[{"minimum":2438,"maximum":2438,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2438,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2438,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2438,"methodology":"case rate"}]}]},{"description":"RL-A-BRAF GENE 2002498","code_information":[{"code":"81210","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":491.31,"maximum":757.36,"gross_charge":927,"discounted_cash":212.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":491.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":757.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-BRAF GENE 2002498","code_information":[{"code":"81210","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":105.24,"maximum":853.62,"gross_charge":927,"discounted_cash":212.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":549.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":412.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":412.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":513.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":491.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":757.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":177.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-BRAF MUTAT DETECT 3017203","code_information":[{"code":"81210","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1965.24,"maximum":3029.44,"gross_charge":3708,"discounted_cash":849.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1965.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3029.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-BRAF MUTAT DETECT 3017203","code_information":[{"code":"81210","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":105.24,"maximum":3029.44,"gross_charge":3708,"discounted_cash":849.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":549.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":412.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":412.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":513.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1965.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3029.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":177.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-BRF MUT W RF MLH1 3017204","code_information":[{"code":"81210","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1908,"maximum":2941.2,"gross_charge":3600,"discounted_cash":824.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1908,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2941.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-BRF MUT W RF MLH1 3017204","code_information":[{"code":"81210","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":105.24,"maximum":2941.2,"gross_charge":3600,"discounted_cash":824.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":549.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":412.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":412.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":513.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1908,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2941.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":105.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":177.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":179.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX CALR EX 9PCR2010673","code_information":[{"code":"81219","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":281.96,"maximum":434.65,"gross_charge":532,"discounted_cash":121.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":434.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX CALR EX 9PCR2010673","code_information":[{"code":"81219","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":72.97,"maximum":591.96,"gross_charge":532,"discounted_cash":121.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":591.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":591.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":285.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":285.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":355.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":434.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":72.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":72.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":122.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":125.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":124.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":124.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":121.63,"methodology":"fee schedule"}]}]},{"description":"POISONING OF MEDICINAL AGENTS","code_information":[{"code":"8122","type":"APR-DRG"}],"standard_charges":[{"minimum":3292,"maximum":3292,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3292,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3292,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3292,"methodology":"case rate"}]}]},{"description":"RL-A-CYST FIBR 165 VAR 2013661","code_information":[{"code":"81220","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":357.75,"maximum":551.48,"gross_charge":675,"discounted_cash":154.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":357.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":551.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYST FIBR 165 VAR 2013661","code_information":[{"code":"81220","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":333.96,"maximum":2708.85,"gross_charge":675,"discounted_cash":154.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2708.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2708.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1743.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1307.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1307.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1628.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1628.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":357.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":551.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":333.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":333.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":556.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":562.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":567.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":556.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":556.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":556.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":570.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":556.6,"methodology":"fee schedule"}]}]},{"description":"CFTR DUP/DEL VAR","code_information":[{"code":"81222","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1471.81,"maximum":2268.81,"gross_charge":2777,"discounted_cash":635.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1471.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2268.81,"methodology":"fee schedule"}]}]},{"description":"CFTR DUP/DEL VAR","code_information":[{"code":"81222","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":261.04,"maximum":2268.81,"gross_charge":2777,"discounted_cash":635.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1362.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1022.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1022.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1272.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1272.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1471.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2268.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":261.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":261.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":261.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":439.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":448.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":443.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":435.07,"methodology":"fee schedule"}]}]},{"description":"CFTR FULL GENE SEQUENCE","code_information":[{"code":"81223","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1471.81,"maximum":2268.81,"gross_charge":2777,"discounted_cash":635.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1471.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2268.81,"methodology":"fee schedule"}]}]},{"description":"CFTR FULL GENE SEQUENCE","code_information":[{"code":"81223","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":299.4,"maximum":2428.51,"gross_charge":2777,"discounted_cash":635.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2428.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2428.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1172.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1172.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1459.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1459.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1471.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2268.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":299.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":299.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":499,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":503.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":513.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":508.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":499,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":499,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":499,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":511.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":499,"methodology":"fee schedule"}]}]},{"description":"CYTOGEN COPY NUM/SNGL VAR","code_information":[{"code":"81229","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":4203.96,"maximum":6480.45,"gross_charge":7932,"discounted_cash":1816.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4203.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6480.45,"methodology":"fee schedule"}]}]},{"description":"CYTOGEN COPY NUM/SNGL VAR","code_information":[{"code":"81229","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":696,"maximum":6480.45,"gross_charge":7932,"discounted_cash":1816.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5645.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5645.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3633.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2725.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2725.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3393,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3393,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4203.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6480.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":696,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":696,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1171.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1194.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1183.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1189,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL SNP MICROARAY 2003414","code_information":[{"code":"81229","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":3543.58,"maximum":5462.47,"gross_charge":6686,"discounted_cash":1531.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3543.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5462.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL SNP MICROARAY 2003414","code_information":[{"code":"81229","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":696,"maximum":5645.44,"gross_charge":6686,"discounted_cash":1531.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5645.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5645.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3633.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2725.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2725.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3393,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3393,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3543.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5462.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":696,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":696,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1189,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1171.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1194.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1183.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1189,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1160,"methodology":"fee schedule"}]}]},{"description":"POISONING OF MEDICINAL AGENTS","code_information":[{"code":"8123","type":"APR-DRG"}],"standard_charges":[{"minimum":4923,"maximum":4923,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4923,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4923,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4923,"methodology":"case rate"}]}]},{"description":"POISONING OF MEDICINAL AGENTS","code_information":[{"code":"8124","type":"APR-DRG"}],"standard_charges":[{"minimum":9450,"maximum":9450,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9450,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9450,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9450,"methodology":"case rate"}]}]},{"description":"F2 GENE ANLS 20210G>A VARIANT","code_information":[{"code":"81240","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"}]}]},{"description":"F2 GENE ANLS 20210G>A VARIANT","code_information":[{"code":"81240","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":39.41,"maximum":319.7,"gross_charge":300,"discounted_cash":68.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":154.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":154.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":192.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":66.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":67.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":67.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-PT G20210A PATH VAR 56060","code_information":[{"code":"81240","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":135.15,"maximum":208.34,"gross_charge":255,"discounted_cash":58.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-PT G20210A PATH VAR 56060","code_information":[{"code":"81240","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":39.41,"maximum":319.7,"gross_charge":255,"discounted_cash":58.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":154.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":154.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":192.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":66.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":67.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":67.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"}]}]},{"description":"F5 LEIDEN VARIANT","code_information":[{"code":"81241","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":203.52,"maximum":313.73,"gross_charge":384,"discounted_cash":87.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":203.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":313.73,"methodology":"fee schedule"}]}]},{"description":"F5 LEIDEN VARIANT","code_information":[{"code":"81241","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":44.02,"maximum":357.06,"gross_charge":384,"discounted_cash":87.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":172.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":172.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":214.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":203.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":313.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":74.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":75.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":74.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"}]}]},{"description":"RL-A-F5 LEIDEN R506Q MUT 97720","code_information":[{"code":"81241","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":168.01,"maximum":258.99,"gross_charge":317,"discounted_cash":72.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":168.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-F5 LEIDEN R506Q MUT 97720","code_information":[{"code":"81241","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":44.02,"maximum":357.06,"gross_charge":317,"discounted_cash":72.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":172.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":172.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":214.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":168.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":74.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":75.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":74.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"methodology":"fee schedule"}]}]},{"description":"RL-A-FRAGX FMR1 WRFLX 2009033","code_information":[{"code":"81243","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":96.99,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-FRAGX FMR1 WRFLX 2009033","code_information":[{"code":"81243","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":34.22,"maximum":277.62,"gross_charge":183,"discounted_cash":41.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":277.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":277.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":134.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":134.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":57.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":57.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":57.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":57.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":57.04,"methodology":"fee schedule"}]}]},{"description":"FLT3 INTRN TANDEM DUP VAR","code_information":[{"code":"81245","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":351.92,"maximum":542.49,"gross_charge":664,"discounted_cash":152.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":351.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":542.49,"methodology":"fee schedule"}]}]},{"description":"FLT3 INTRN TANDEM DUP VAR","code_information":[{"code":"81245","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":99.3,"maximum":805.52,"gross_charge":664,"discounted_cash":152.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":805.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":805.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":388.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":388.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":484.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":484.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":351.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":542.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":99.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":99.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":165.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":167.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":170.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":168.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":165.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":165.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":165.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":169.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":165.51,"methodology":"fee schedule"}]}]},{"description":"FLT3 DOMAIN VARIENTS","code_information":[{"code":"81246","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":351.92,"maximum":542.49,"gross_charge":664,"discounted_cash":152.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":351.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":542.49,"methodology":"fee schedule"}]}]},{"description":"FLT3 DOMAIN VARIENTS","code_information":[{"code":"81246","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":49.8,"maximum":1148.63,"gross_charge":664,"discounted_cash":152.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":403.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":403.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1148.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":861.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":861.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":242.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":351.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":542.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":49.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":83.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":85.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":84.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":85.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":83,"methodology":"fee schedule"}]}]},{"description":"RL-A-HFE 3 MUTATIONS 55656","code_information":[{"code":"81256","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":155.29,"maximum":239.39,"gross_charge":293,"discounted_cash":67.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":155.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":239.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-HFE 3 MUTATIONS 55656","code_information":[{"code":"81256","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":39.21,"maximum":318.06,"gross_charge":293,"discounted_cash":67.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":153.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":153.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":155.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":239.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":67.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX ALPHA THAL 2005834","code_information":[{"code":"81259","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":743.59,"maximum":1146.26,"gross_charge":1403,"discounted_cash":321.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":743.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1146.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX ALPHA THAL 2005834","code_information":[{"code":"81259","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":360,"maximum":2920.06,"gross_charge":1403,"discounted_cash":321.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2920.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2920.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1879.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1409.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1409.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1755,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1755,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":743.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1146.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":360,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":360,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":615,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":615,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":615,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":600,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":606,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":618,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":612,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":600,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":600,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":600,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":615,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":600,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX HBADD 2011646","code_information":[{"code":"81269","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":685.82,"maximum":1057.2,"gross_charge":1294,"discounted_cash":296.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":685.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1057.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX HBADD 2011646","code_information":[{"code":"81269","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":121.44,"maximum":1057.2,"gross_charge":1294,"discounted_cash":296.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":985.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":985.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":633.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":475.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":475.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":592.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":592.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":685.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1057.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":121.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":121.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":204.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":206.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"}]}]},{"description":"JAK2 P VAL617PHE VAR","code_information":[{"code":"81270","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":210.41,"maximum":324.35,"gross_charge":397,"discounted_cash":90.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":210.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.35,"methodology":"fee schedule"}]}]},{"description":"JAK2 P VAL617PHE VAR","code_information":[{"code":"81270","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":54.99,"maximum":446.1,"gross_charge":397,"discounted_cash":90.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":446.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":446.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":287.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":215.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":215.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":210.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":92.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"}]}]},{"description":"RL-A-JAK2 MUT QUAL CAL 3016839","code_information":[{"code":"81270","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":200.34,"maximum":308.83,"gross_charge":378,"discounted_cash":86.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":200.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-JAK2 MUT QUAL CAL 3016839","code_information":[{"code":"81270","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":54.99,"maximum":446.1,"gross_charge":378,"discounted_cash":86.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":446.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":446.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":287.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":215.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":215.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":200.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":92.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"}]}]},{"description":"RL-A-JAK2 MUT QUAL CALR3003800","code_information":[{"code":"81270","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":189.21,"maximum":291.67,"gross_charge":357,"discounted_cash":81.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-JAK2 MUT QUAL CALR3003800","code_information":[{"code":"81270","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":54.99,"maximum":446.1,"gross_charge":357,"discounted_cash":81.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":446.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":446.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":287.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":215.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":215.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":92.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"methodology":"fee schedule"}]}]},{"description":"RL-A-HD CAG REPEAT EXP 3016908","code_information":[{"code":"81271","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":298.92,"maximum":460.79,"gross_charge":564,"discounted_cash":129.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":298.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":460.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-HD CAG REPEAT EXP 3016908","code_information":[{"code":"81271","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":82.2,"maximum":666.75,"gross_charge":564,"discounted_cash":129.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":666.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":666.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":321.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":321.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":400.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":298.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":460.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"}]}]},{"description":"RL-A-HD MUTATION PCR 40018","code_information":[{"code":"81271","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":101.23,"maximum":156.05,"gross_charge":191,"discounted_cash":43.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-HD MUTATION PCR 40018","code_information":[{"code":"81271","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":82.2,"maximum":666.75,"gross_charge":191,"discounted_cash":43.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":666.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":666.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":321.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":321.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":400.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"}]}]},{"description":"KIT MUTATION ANALYSIS","code_information":[{"code":"81272","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1926.02,"maximum":2968.98,"gross_charge":3634,"discounted_cash":832.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1926.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2968.98,"methodology":"fee schedule"}]}]},{"description":"KIT MUTATION ANALYSIS","code_information":[{"code":"81272","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":197.7,"maximum":2968.98,"gross_charge":3634,"discounted_cash":832.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1603.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1603.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1032.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":774.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":774.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":963.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1926.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2968.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":332.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":339.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":336.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-KIT GENE SEQ ANL 3004283A","code_information":[{"code":"81272","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":698.54,"maximum":1076.81,"gross_charge":1318,"discounted_cash":301.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":698.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1076.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-KIT GENE SEQ ANL 3004283A","code_information":[{"code":"81272","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":197.7,"maximum":1603.67,"gross_charge":1318,"discounted_cash":301.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1603.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1603.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1032.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":774.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":774.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":963.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":698.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1076.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":332.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":339.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":336.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-JAK2 EX12 MUT PCR 2002357","code_information":[{"code":"81279","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":131.44,"maximum":202.62,"gross_charge":248,"discounted_cash":56.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":202.62,"methodology":"fee schedule"}]}]},{"description":"RL-A-JAK2 EX12 MUT PCR 2002357","code_information":[{"code":"81279","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":111.12,"maximum":901.35,"gross_charge":248,"discounted_cash":56.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":901.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":901.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":435.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":435.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":541.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":541.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":202.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":187.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":190.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":188.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-MGMT METH DDPCR 3005956","code_information":[{"code":"81287","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":241.68,"maximum":372.56,"gross_charge":456,"discounted_cash":104.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":241.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":372.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-MGMT METH DDPCR 3005956","code_information":[{"code":"81287","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":74.78,"maximum":606.63,"gross_charge":456,"discounted_cash":104.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":606.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":606.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":292.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":292.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":364.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":241.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":372.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":125.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":128.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":127.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":127.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":124.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-MLH1 PROMOTER 3004308","code_information":[{"code":"81288","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":407.57,"maximum":628.28,"gross_charge":769,"discounted_cash":176.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":407.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":628.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-MLH1 PROMOTER 3004308","code_information":[{"code":"81288","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":115.39,"maximum":935.99,"gross_charge":769,"discounted_cash":176.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":935.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":935.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":451.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":451.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":562.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":407.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":628.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":115.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":115.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":194.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":198.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":196.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":197.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":192.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX MLH1 PROMOTER 51747","code_information":[{"code":"81288","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":82.68,"maximum":127.46,"gross_charge":156,"discounted_cash":35.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX MLH1 PROMOTER 51747","code_information":[{"code":"81288","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":82.68,"maximum":935.99,"gross_charge":156,"discounted_cash":35.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":935.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":935.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":451.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":451.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":562.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":115.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":115.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":157.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":160.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":159.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":159.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"}]}]},{"description":"MTHFR COMMON VARIANTS","code_information":[{"code":"81291","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":187.09,"maximum":288.41,"gross_charge":353,"discounted_cash":80.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":288.41,"methodology":"fee schedule"}]}]},{"description":"MTHFR COMMON VARIANTS","code_information":[{"code":"81291","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":39.2,"maximum":317.99,"gross_charge":353,"discounted_cash":80.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":153.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":153.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":191.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":288.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":66.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":66.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-MTHFR 2 VARIANTS 55655","code_information":[{"code":"81291","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":69.43,"maximum":107.03,"gross_charge":131,"discounted_cash":30,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-MTHFR 2 VARIANTS 55655","code_information":[{"code":"81291","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":39.2,"maximum":317.99,"gross_charge":131,"discounted_cash":30,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":153.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":153.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":191.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":66.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":66.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"}]}]},{"description":"COAGULATION DISORDERS","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"minimum":13244.01,"maximum":32702.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29777,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29777,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28497.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21373.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21373.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":28811.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23758.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32702.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13244.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13376.46,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13641.34,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13508.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13244.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13244.01,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13244.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13575.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13244.01,"methodology":"case rate"}]}]},{"description":"OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"8131","type":"APR-DRG"}],"standard_charges":[{"minimum":3796,"maximum":3796,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3796,"methodology":"case rate"}]}]},{"description":"NPM1 EXON 12 VAR","code_information":[{"code":"81310","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":883.51,"maximum":1361.94,"gross_charge":1667,"discounted_cash":381.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":883.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1361.94,"methodology":"fee schedule"}]}]},{"description":"NPM1 EXON 12 VAR","code_information":[{"code":"81310","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":147.91,"maximum":1361.94,"gross_charge":1667,"discounted_cash":381.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1199.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1199.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":772.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":579.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":579.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":721.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":721.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":883.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1361.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":246.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":248.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":253.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":251.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":246.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":246.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":246.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":252.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":246.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-PDGFRA TARG SEQ 3004283B","code_information":[{"code":"81314","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":461.1,"maximum":710.79,"gross_charge":870,"discounted_cash":199.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":461.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":710.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-PDGFRA TARG SEQ 3004283B","code_information":[{"code":"81314","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":197.7,"maximum":1603.67,"gross_charge":870,"discounted_cash":199.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1603.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1603.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1032.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":774.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":774.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":963.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":461.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":710.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":332.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":339.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":336.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"}]}]},{"description":"RL-NG-PDGFRA MUT ANA","code_information":[{"code":"81314","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":272.95,"maximum":420.76,"gross_charge":515,"discounted_cash":117.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":272.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.76,"methodology":"fee schedule"}]}]},{"description":"RL-NG-PDGFRA MUT ANA","code_information":[{"code":"81314","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":197.7,"maximum":1603.67,"gross_charge":515,"discounted_cash":117.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1603.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1603.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1032.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":774.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":774.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":963.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":272.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":332.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":339.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":336.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":329.51,"methodology":"fee schedule"}]}]},{"description":"PML/RARALPHA COM BRKPTS","code_information":[{"code":"81315","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":474.88,"maximum":732.04,"gross_charge":896,"discounted_cash":205.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"}]}]},{"description":"PML/RARALPHA COM BRKPTS","code_information":[{"code":"81315","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":124.38,"maximum":1008.92,"gross_charge":896,"discounted_cash":205.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1008.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1008.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":606.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":606.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":124.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":124.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":209.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":213.53,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":212.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":207.31,"methodology":"fee schedule"}]}]},{"description":"OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"8132","type":"APR-DRG"}],"standard_charges":[{"minimum":4690,"maximum":4690,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4690,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4690,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4690,"methodology":"case rate"}]}]},{"description":"OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"8133","type":"APR-DRG"}],"standard_charges":[{"minimum":6963,"maximum":6963,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6963,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6963,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6963,"methodology":"case rate"}]}]},{"description":"RL-A-AS PWS MLPA 3006247","code_information":[{"code":"81331","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":710.2,"maximum":1094.78,"gross_charge":1340,"discounted_cash":306.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":710.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1094.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-AS PWS MLPA 3006247","code_information":[{"code":"81331","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":30.64,"maximum":1094.78,"gross_charge":1340,"discounted_cash":306.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":149.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":710.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1094.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-AS PWS PCR 2005077","code_information":[{"code":"81331","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":60.95,"maximum":93.96,"gross_charge":115,"discounted_cash":26.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-AS PWS PCR 2005077","code_information":[{"code":"81331","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":30.64,"maximum":248.56,"gross_charge":115,"discounted_cash":26.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":149.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":51.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL MPL CAPIL ELEC2005545","code_information":[{"code":"81338","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":789.17,"maximum":1216.52,"gross_charge":1489,"discounted_cash":340.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":789.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1216.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL MPL CAPIL ELEC2005545","code_information":[{"code":"81338","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":90.19,"maximum":1216.52,"gross_charge":1489,"discounted_cash":340.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":731.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":731.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":470.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":353.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":353.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":439.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":789.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1216.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":90.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":90.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":151.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":154.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":153.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":154.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"}]}]},{"description":"OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"8134","type":"APR-DRG"}],"standard_charges":[{"minimum":13466,"maximum":13466,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13466,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13466,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13466,"methodology":"case rate"}]}]},{"description":"TRB AMPLIFICATION METHOD","code_information":[{"code":"81340","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":11177.17,"maximum":17229.72,"gross_charge":21089,"discounted_cash":4829.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11177.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17229.72,"methodology":"fee schedule"}]}]},{"description":"TRB AMPLIFICATION METHOD","code_information":[{"code":"81340","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":125.35,"maximum":17229.72,"gross_charge":21089,"discounted_cash":4829.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1016.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1016.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":490.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":490.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":611.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":611.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11177.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17229.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":125.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":125.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":208.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":211.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":215.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":213.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":208.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":208.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":208.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":214.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":208.92,"methodology":"fee schedule"}]}]},{"description":"TRG EVAL ABNORM CLON POP","code_information":[{"code":"81342","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":11177.17,"maximum":17229.72,"gross_charge":21089,"discounted_cash":4829.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11177.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17229.72,"methodology":"fee schedule"}]}]},{"description":"TRG EVAL ABNORM CLON POP","code_information":[{"code":"81342","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":120.9,"maximum":17229.72,"gross_charge":21089,"discounted_cash":4829.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":980.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":473.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":473.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":589.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11177.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17229.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":120.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":120.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":201.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":203.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":207.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":205.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":201.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":201.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":201.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":206.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":201.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BG DD 2011857","code_information":[{"code":"81363","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1070.07,"maximum":1649.53,"gross_charge":2019,"discounted_cash":462.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1070.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1649.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BG DD 2011857","code_information":[{"code":"81363","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":121.44,"maximum":1649.53,"gross_charge":2019,"discounted_cash":462.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":985.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":985.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":633.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":475.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":475.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":592.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":592.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1070.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1649.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":121.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":121.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":204.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":206.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":202.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-REFLEX BILL BGNGS 3004562","code_information":[{"code":"81364","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1908,"maximum":2941.2,"gross_charge":3600,"discounted_cash":824.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1908,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2941.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-REFLEX BILL BGNGS 3004562","code_information":[{"code":"81364","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":194.74,"maximum":2941.2,"gross_charge":3600,"discounted_cash":824.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1579.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1579.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1016.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":762.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":762.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":949.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":949.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1908,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2941.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":327.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":334.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":331.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":332.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":324.58,"methodology":"fee schedule"}]}]},{"description":"HLA I/II LR ABC W DQB1","code_information":[{"code":"81370","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1299.56,"maximum":2003.29,"gross_charge":2452,"discounted_cash":561.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1299.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2003.29,"methodology":"fee schedule"}]}]},{"description":"HLA I/II LR ABC W DQB1","code_information":[{"code":"81370","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":241.27,"maximum":2003.29,"gross_charge":2452,"discounted_cash":561.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1957.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1957.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1259.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":944.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":944.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1176.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1176.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1299.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2003.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":241.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":241.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":402.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":406.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":414.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":410.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":402.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":402.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":402.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":402.12,"methodology":"fee schedule"}]}]},{"description":"BSL HLA(A B C DR DQ)IR","code_information":[{"code":"81371","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":743.06,"maximum":1145.44,"gross_charge":1402,"discounted_cash":321.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":743.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1145.44,"methodology":"fee schedule"}]}]},{"description":"BSL HLA(A B C DR DQ)IR","code_information":[{"code":"81371","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":242.71,"maximum":1968.68,"gross_charge":1402,"discounted_cash":321.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1968.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1968.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1267.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":950.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":950.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1183.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1183.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":743.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1145.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":242.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":242.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":408.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":416.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":412.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":414.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":404.52,"methodology":"fee schedule"}]}]},{"description":"HLA I LR ONE LOCUS EA","code_information":[{"code":"81373","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":248.57,"maximum":383.18,"gross_charge":469,"discounted_cash":107.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":248.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.18,"methodology":"fee schedule"}]}]},{"description":"HLA I LR ONE LOCUS EA","code_information":[{"code":"81373","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":76.45,"maximum":620.15,"gross_charge":469,"discounted_cash":107.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":620.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":620.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":399.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":299.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":299.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":372.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":372.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":248.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":76.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":76.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":128.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":131.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":129.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":130.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":127.43,"methodology":"fee schedule"}]}]},{"description":"HLA I/II HR HLAA B C/DRB1","code_information":[{"code":"81378","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1087.03,"maximum":1675.67,"gross_charge":2051,"discounted_cash":469.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1087.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1675.67,"methodology":"fee schedule"}]}]},{"description":"HLA I/II HR HLAA B C/DRB1","code_information":[{"code":"81378","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":207.34,"maximum":1681.82,"gross_charge":2051,"discounted_cash":469.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1681.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1681.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1082.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":811.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":811.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1010.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1010.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1087.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1675.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":207.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":207.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":349.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":355.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":352.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":354.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":345.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-HLA-B5701 ABACAVIR2002429","code_information":[{"code":"81381","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":359.87,"maximum":554.75,"gross_charge":679,"discounted_cash":155.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":359.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-HLA-B5701 ABACAVIR2002429","code_information":[{"code":"81381","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":101.94,"maximum":826.85,"gross_charge":679,"discounted_cash":155.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":826.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":826.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":399.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":399.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":496.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":496.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":359.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":101.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":101.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":169.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":171.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":175,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":173.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":169.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":169.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":169.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":169.9,"methodology":"fee schedule"}]}]},{"description":"HLA II HR ONE LOCUS EA","code_information":[{"code":"81382","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":389.02,"maximum":599.68,"gross_charge":734,"discounted_cash":168.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":389.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":599.68,"methodology":"fee schedule"}]}]},{"description":"HLA II HR ONE LOCUS EA","code_information":[{"code":"81382","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":74.2,"maximum":601.9,"gross_charge":734,"discounted_cash":168.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":601.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":290.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":290.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":361.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":361.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":389.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":599.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":124.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":127.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":126.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":126.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":123.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-NARCOLEPSY GENOTY 2005023","code_information":[{"code":"81383","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":386.9,"maximum":596.41,"gross_charge":730,"discounted_cash":167.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":386.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"}]}]},{"description":"RL-A-NARCOLEPSY GENOTY 2005023","code_information":[{"code":"81383","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":65.47,"maximum":596.41,"gross_charge":730,"discounted_cash":167.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":531.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":531.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":341.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":256.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":319.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":386.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":109.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":110.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":112.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":111.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":109.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":109.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":109.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":109.13,"methodology":"fee schedule"}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"minimum":16537.84,"maximum":36083.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32856,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32856,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22050.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16537.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16537.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31789.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26215.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36083.93,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17439.18,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17613.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17962.36,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17787.97,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17439.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17439.18,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17439.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17875.16,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17439.18,"methodology":"case rate"}]}]},{"description":"MOPATH PROC LEVEL 1","code_information":[{"code":"81400","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":708.61,"maximum":1092.33,"gross_charge":1337,"discounted_cash":306.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":708.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1092.33,"methodology":"fee schedule"}]}]},{"description":"MOPATH PROC LEVEL 1","code_information":[{"code":"81400","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":38.37,"maximum":1092.33,"gross_charge":1337,"discounted_cash":306.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":311.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":150.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":150.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":187.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":708.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1092.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":65.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":65.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.96,"methodology":"fee schedule"}]}]},{"description":"MOPATH PROC LEVEL 2","code_information":[{"code":"81401","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":472.23,"maximum":727.95,"gross_charge":891,"discounted_cash":204.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":472.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":727.95,"methodology":"fee schedule"}]}]},{"description":"MOPATH PROC LEVEL 2","code_information":[{"code":"81401","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":82.2,"maximum":727.95,"gross_charge":891,"discounted_cash":204.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":666.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":666.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":321.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":321.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":400.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":472.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":727.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"}]}]},{"description":"RL-A-APOE CARDIO RISK 2013337","code_information":[{"code":"81401","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":157.41,"maximum":242.65,"gross_charge":297,"discounted_cash":68.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-APOE CARDIO RISK 2013337","code_information":[{"code":"81401","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":82.2,"maximum":666.75,"gross_charge":297,"discounted_cash":68.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":666.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":666.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":321.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":321.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":400.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"}]}]},{"description":"MOLEC EXT RED CELL PHENO","code_information":[{"code":"81403","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":708.61,"maximum":1092.33,"gross_charge":1337,"discounted_cash":306.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":708.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1092.33,"methodology":"fee schedule"}]}]},{"description":"MOLEC EXT RED CELL PHENO","code_information":[{"code":"81403","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":111.12,"maximum":1092.33,"gross_charge":1337,"discounted_cash":306.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":901.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":901.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":435.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":435.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":541.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":541.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":708.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1092.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":187.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":190.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":188.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"}]}]},{"description":"MOPATH PROC LEVEL 3","code_information":[{"code":"81403","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":569.22,"maximum":877.46,"gross_charge":1074,"discounted_cash":245.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":569.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":877.46,"methodology":"fee schedule"}]}]},{"description":"MOPATH PROC LEVEL 3","code_information":[{"code":"81403","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":111.12,"maximum":901.35,"gross_charge":1074,"discounted_cash":245.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":901.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":901.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":435.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":435.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":541.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":541.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":569.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":877.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":187.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":190.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":188.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"methodology":"fee schedule"}]}]},{"description":"MOPATH PROC LEVEL 7","code_information":[{"code":"81406","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1180.84,"maximum":1820.28,"gross_charge":2228,"discounted_cash":510.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1180.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1820.28,"methodology":"fee schedule"}]}]},{"description":"MOPATH PROC LEVEL 7","code_information":[{"code":"81406","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":169.72,"maximum":1820.28,"gross_charge":2228,"discounted_cash":510.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1376.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1376.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":886.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":664.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":664.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":827.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1180.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1820.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":169.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":169.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":285.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":291.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":289.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":282.88,"methodology":"fee schedule"}]}]},{"description":"INTELLIGEN MYELOID","code_information":[{"code":"81450","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":6419.89,"maximum":9896.33,"gross_charge":12113,"discounted_cash":2773.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6419.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9896.33,"methodology":"fee schedule"}]}]},{"description":"INTELLIGEN MYELOID","code_information":[{"code":"81450","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":455.71,"maximum":9896.33,"gross_charge":12113,"discounted_cash":2773.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3696.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3696.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2378.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1784.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1784.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2221.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2221.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6419.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9896.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":455.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":455.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":455.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":759.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":767.13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":782.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":774.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":759.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":759.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":759.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":778.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":759.53,"methodology":"fee schedule"}]}]},{"description":"MOLECUL PLATELET GENO","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":593.6,"maximum":915.04,"gross_charge":1120,"discounted_cash":256.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":593.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":915.04,"methodology":"fee schedule"}]}]},{"description":"MOLECUL PLATELET GENO","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":156.8,"maximum":915.04,"gross_charge":1120,"discounted_cash":256.48,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":491.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":593.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":915.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BILLHBGFGS 3003509","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1416.16,"maximum":2183.03,"gross_charge":2672,"discounted_cash":611.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1416.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2183.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BILLHBGFGS 3003509","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":374.08,"maximum":2183.03,"gross_charge":2672,"discounted_cash":611.89,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":491.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1416.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2183.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX HGB LEPOR 2005838","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":345.03,"maximum":531.87,"gross_charge":651,"discounted_cash":149.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":345.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":531.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX HGB LEPOR 2005838","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":91.14,"maximum":531.87,"gross_charge":651,"discounted_cash":149.08,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":491.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":345.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":531.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-UNLIST MOL PATH 3004486B","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":384.25,"maximum":592.33,"gross_charge":725,"discounted_cash":166.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":384.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":592.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-UNLIST MOL PATH 3004486B","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":101.5,"maximum":592.33,"gross_charge":725,"discounted_cash":166.03,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":393.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":491.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":384.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":592.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.5,"methodology":"fee schedule"}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"minimum":9130.82,"maximum":20894.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19025,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19025,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17215.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12911.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12911.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18407.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15179.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20894.06,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9130.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9222.13,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9404.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9313.44,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9130.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9130.82,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9130.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9359.1,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9130.82,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES","code_information":[{"code":"8151","type":"APR-DRG"}],"standard_charges":[{"minimum":2831,"maximum":2831,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2831,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2831,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2831,"methodology":"case rate"}]}]},{"description":"RL-A-MATERNAL SRM SCRN 3000143","code_information":[{"code":"81511","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":438.84,"maximum":676.48,"gross_charge":828,"discounted_cash":189.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":438.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":676.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-MATERNAL SRM SCRN 3000143","code_information":[{"code":"81511","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":92.1,"maximum":747.05,"gross_charge":828,"discounted_cash":189.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":747.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":747.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":424.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":318.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":318.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":449.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":449.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":438.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":676.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":92.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":92.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":153.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":155.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":158.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":156.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":153.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":153.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":153.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":157.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":153.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-VAGINOS PNL TMA 3002581A","code_information":[{"code":"81513","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":302.1,"maximum":465.69,"gross_charge":570,"discounted_cash":130.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-VAGINOS PNL TMA 3002581A","code_information":[{"code":"81513","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":85.57,"maximum":694.16,"gross_charge":570,"discounted_cash":130.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":694.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":694.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":417.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":144.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":146.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":145.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"}]}]},{"description":"ONC BRST MRNA 21 GENE PRFILING","code_information":[{"code":"81519","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":8123.84,"maximum":12522.98,"gross_charge":15328,"discounted_cash":3510.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8123.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12522.98,"methodology":"fee schedule"}]}]},{"description":"ONC BRST MRNA 21 GENE PRFILING","code_information":[{"code":"81519","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":2323.8,"maximum":18848.96,"gross_charge":15328,"discounted_cash":3510.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18848.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18848.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11173.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8381.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8381.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11328.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11328.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8123.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12522.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2323.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2323.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2323.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3969.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3969.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3969.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3873,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3911.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3989.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3873,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3873,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3873,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3969.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3873,"methodology":"fee schedule"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES","code_information":[{"code":"8152","type":"APR-DRG"}],"standard_charges":[{"minimum":3652,"maximum":3652,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3652,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3652,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3652,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES","code_information":[{"code":"8153","type":"APR-DRG"}],"standard_charges":[{"minimum":6156,"maximum":6156,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6156,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6156,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6156,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES","code_information":[{"code":"8154","type":"APR-DRG"}],"standard_charges":[{"minimum":16065,"maximum":16065,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16065,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16065,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16065,"methodology":"case rate"}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"minimum":6372.45,"maximum":43179.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13448,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13448,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43179.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32385.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32385.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13011.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10729.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14769.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6372.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6436.18,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6563.63,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6499.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6372.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6372.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6372.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6531.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6372.45,"methodology":"case rate"}]}]},{"description":"TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES","code_information":[{"code":"8161","type":"APR-DRG"}],"standard_charges":[{"minimum":3758,"maximum":3758,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"}]}]},{"description":"TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES","code_information":[{"code":"8162","type":"APR-DRG"}],"standard_charges":[{"minimum":3758,"maximum":3758,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3758,"methodology":"case rate"}]}]},{"description":"TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES","code_information":[{"code":"8163","type":"APR-DRG"}],"standard_charges":[{"minimum":4787,"maximum":4787,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4787,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4787,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4787,"methodology":"case rate"}]}]},{"description":"TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES","code_information":[{"code":"8164","type":"APR-DRG"}],"standard_charges":[{"minimum":9811,"maximum":9811,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9811,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9811,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9811,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"minimum":17794.21,"maximum":51909.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47266,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47266,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23725.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17794.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17794.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":45731.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37712.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51909.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20877.28,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21086.06,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21503.6,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21294.83,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20877.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20877.28,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20877.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21399.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20877.28,"methodology":"case rate"}]}]},{"description":"INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE","code_information":[{"code":"8171","type":"APR-DRG"}],"standard_charges":[{"minimum":2396,"maximum":2396,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2396,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2396,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2396,"methodology":"case rate"}]}]},{"description":"INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE","code_information":[{"code":"8172","type":"APR-DRG"}],"standard_charges":[{"minimum":3030,"maximum":3030,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3030,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3030,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3030,"methodology":"case rate"}]}]},{"description":"INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE","code_information":[{"code":"8173","type":"APR-DRG"}],"standard_charges":[{"minimum":4953,"maximum":4953,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4953,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4953,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4953,"methodology":"case rate"}]}]},{"description":"INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE","code_information":[{"code":"8174","type":"APR-DRG"}],"standard_charges":[{"minimum":9903,"maximum":9903,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9903,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9903,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9903,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"minimum":10076.9,"maximum":26280.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23930,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23930,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13435.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10076.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10076.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23153.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19093.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26280.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11233.43,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11345.77,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11570.44,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11458.1,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11233.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11233.43,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11233.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11514.27,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11233.43,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"minimum":7587.31,"maximum":112157.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14988,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14988,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112157.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":84119.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":84119.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14501.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11958.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16460.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7663.19,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7814.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7739.06,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7777,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7587.31,"methodology":"case rate"}]}]},{"description":"HEMO/OP OR HOME","code_information":[{"code":"820","type":"RC"}],"standard_charges":[{"minimum":846,"maximum":1866.01,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1866.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1399.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1399.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1026,"methodology":"case rate"}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"minimum":46297.26,"maximum":117935.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107388,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107388,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66956.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50218.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50218.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":103901.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":85681.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":117935.52,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":46297.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":46760.24,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":47686.18,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":47223.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":46297.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":46297.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":46297.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":47454.7,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":46297.26,"methodology":"case rate"}]}]},{"description":"ACETONE KETONES QL","code_information":[{"code":"82009","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":63.07,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"ACETONE KETONES QL","code_information":[{"code":"82009","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.71,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"}]}]},{"description":"ACETONE KETONES QN","code_information":[{"code":"82010","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":150.52,"maximum":232.03,"gross_charge":284,"discounted_cash":65.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":150.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.03,"methodology":"fee schedule"}]}]},{"description":"ACETONE KETONES QN","code_information":[{"code":"82010","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.9,"maximum":232.03,"gross_charge":284,"discounted_cash":65.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":150.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-HYDROXYBUTYRIC 80045","code_information":[{"code":"82010","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-HYDROXYBUTYRIC 80045","code_information":[{"code":"82010","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.9,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACETYLCHOLINEST 2006848A","code_information":[{"code":"82013","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":92.75,"maximum":142.98,"gross_charge":175,"discounted_cash":40.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":92.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":142.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACETYLCHOLINEST 2006848A","code_information":[{"code":"82013","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.37,"maximum":142.98,"gross_charge":175,"discounted_cash":40.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":92.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":142.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"}]}]},{"description":"ACYLCARNITINES QN EA SPECIMEN","code_information":[{"code":"82017","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":447.32,"maximum":689.55,"gross_charge":844,"discounted_cash":193.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":447.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":689.55,"methodology":"fee schedule"}]}]},{"description":"ACYLCARNITINES QN EA SPECIMEN","code_information":[{"code":"82017","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.12,"maximum":689.55,"gross_charge":844,"discounted_cash":193.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":447.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":689.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACYLCARNITINE QN 40033","code_information":[{"code":"82017","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.41,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACYLCARNITINE QN 40033","code_information":[{"code":"82017","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.12,"maximum":82.09,"gross_charge":97,"discounted_cash":22.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"ADRENOCORTICOTROPIC (ACTH)","code_information":[{"code":"82024","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":225.25,"maximum":347.23,"gross_charge":425,"discounted_cash":97.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":225.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":347.23,"methodology":"fee schedule"}]}]},{"description":"ADRENOCORTICOTROPIC (ACTH)","code_information":[{"code":"82024","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.17,"maximum":347.23,"gross_charge":425,"discounted_cash":97.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":112.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":225.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":347.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":39.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADRENOCORTI HORMONE 70010","code_information":[{"code":"82024","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":115.54,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADRENOCORTI HORMONE 70010","code_information":[{"code":"82024","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.17,"maximum":187.94,"gross_charge":218,"discounted_cash":49.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":112.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":39.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN SERUM/PLASMA/BLD","code_information":[{"code":"82040","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.2,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN SERUM/PLASMA/BLD","code_information":[{"code":"82040","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALBUMIN SRM/PLS/BLD50676A","code_information":[{"code":"82040","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.43,"maximum":25.33,"gross_charge":31,"discounted_cash":7.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALBUMIN SRM/PLS/BLD50676A","code_information":[{"code":"82040","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":25.33,"gross_charge":31,"discounted_cash":7.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN OTHER QN","code_information":[{"code":"82042","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":60.42,"maximum":93.14,"gross_charge":114,"discounted_cash":26.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN OTHER QN","code_information":[{"code":"82042","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.66,"maximum":93.14,"gross_charge":114,"discounted_cash":26.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"}]}]},{"description":"RL-ALBUMIN OTH SRC QUAN 50676B","code_information":[{"code":"82042","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.96,"maximum":26.15,"gross_charge":32,"discounted_cash":7.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"}]}]},{"description":"RL-ALBUMIN OTH SRC QUAN 50676B","code_information":[{"code":"82042","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.66,"maximum":37.86,"gross_charge":32,"discounted_cash":7.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"}]}]},{"description":"RL-ALBUMIN OTH SRC QUAN 80440A","code_information":[{"code":"82042","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"RL-ALBUMIN OTH SRC QUAN 80440A","code_information":[{"code":"82042","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.66,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"}]}]},{"description":"MICROALBUMIN URINE 24 HOUR","code_information":[{"code":"82043","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":62.01,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"}]}]},{"description":"MICROALBUMIN URINE 24 HOUR","code_information":[{"code":"82043","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.46,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"}]}]},{"description":"MICROALBUMIN URINE QN","code_information":[{"code":"82043","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":109.71,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"}]}]},{"description":"MICROALBUMIN URINE QN","code_information":[{"code":"82043","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.46,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-MICROALBUMIN UR QN 50203A","code_information":[{"code":"82043","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.19,"maximum":18.8,"gross_charge":23,"discounted_cash":5.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-MICROALBUMIN UR QN 50203A","code_information":[{"code":"82043","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.46,"maximum":28.13,"gross_charge":23,"discounted_cash":5.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALDOLASE SERUM 20012","code_information":[{"code":"82085","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":90.63,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALDOLASE SERUM 20012","code_information":[{"code":"82085","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.82,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALDOSTERONE SERUM 70015","code_information":[{"code":"82088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":259.17,"maximum":399.52,"gross_charge":489,"discounted_cash":111.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":259.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":399.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALDOSTERONE SERUM 70015","code_information":[{"code":"82088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.45,"maximum":399.52,"gross_charge":489,"discounted_cash":111.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":84.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":84.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":119.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":259.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":399.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":41.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":41.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":40.75,"methodology":"fee schedule"}]}]},{"description":"HEMO/COMPOSITE","code_information":[{"code":"821","type":"RC"}],"standard_charges":[{"minimum":593.2,"maximum":1026,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":593.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":593.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1026,"methodology":"case rate"}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"minimum":18536.49,"maximum":46052.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41933,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41933,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39877.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29908.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29908.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":40572.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":33457.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46052.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18536.49,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18721.86,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19092.59,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18907.22,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18536.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18536.49,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18536.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18999.91,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18536.49,"methodology":"case rate"}]}]},{"description":"RL-A-ALPHA1 ANTITRY TOT 80500B","code_information":[{"code":"82103","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":49.29,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALPHA1 ANTITRY TOT 80500B","code_information":[{"code":"82103","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.06,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALPHA-1 ANTITRYPSIN 50001","code_information":[{"code":"82103","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":31.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALPHA-1 ANTITRYPSIN 50001","code_information":[{"code":"82103","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.06,"maximum":65.41,"gross_charge":59,"discounted_cash":13.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-A1A PHENOTYPE 80500A","code_information":[{"code":"82104","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":53.53,"maximum":82.52,"gross_charge":101,"discounted_cash":23.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-A1A PHENOTYPE 80500A","code_information":[{"code":"82104","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.67,"maximum":82.52,"gross_charge":101,"discounted_cash":23.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"}]}]},{"description":"ALPHA FETOPROTEIN (AFP) SERUM","code_information":[{"code":"82105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":152.64,"maximum":235.3,"gross_charge":288,"discounted_cash":65.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":152.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"}]}]},{"description":"ALPHA FETOPROTEIN (AFP) SERUM","code_information":[{"code":"82105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.06,"maximum":235.3,"gross_charge":288,"discounted_cash":65.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":152.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALPHA FETOPROTEI S 80428","code_information":[{"code":"82105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALPHA FETOPROTEI S 80428","code_information":[{"code":"82105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.06,"maximum":81.59,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-AFP AMNIO FL/RFLX 3000142","code_information":[{"code":"82106","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-AFP AMNIO FL/RFLX 3000142","code_information":[{"code":"82106","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.2,"maximum":82.73,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALPHA-FETOPROT L3 81326A","code_information":[{"code":"82107","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":134.09,"maximum":206.71,"gross_charge":253,"discounted_cash":57.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALPHA-FETOPROT L3 81326A","code_information":[{"code":"82107","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.64,"maximum":313.48,"gross_charge":253,"discounted_cash":57.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":133.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":133.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":188.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":65.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":66.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":65.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":66.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALUMINUM SERUM 99266","code_information":[{"code":"82108","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":83.74,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALUMINUM SERUM 99266","code_information":[{"code":"82108","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.28,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYSTINE QN URINE 81106","code_information":[{"code":"82131","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":127.2,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYSTINE QN URINE 81106","code_information":[{"code":"82131","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.78,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHENYLALANINE MON P 80315","code_information":[{"code":"82131","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":32.33,"maximum":49.84,"gross_charge":61,"discounted_cash":13.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHENYLALANINE MON P 80315","code_information":[{"code":"82131","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.78,"maximum":111.86,"gross_charge":61,"discounted_cash":13.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMINOLEVULINIC AC U 80103","code_information":[{"code":"82135","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":143.1,"maximum":220.59,"gross_charge":270,"discounted_cash":61.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMINOLEVULINIC AC U 80103","code_information":[{"code":"82135","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.87,"maximum":220.59,"gross_charge":270,"discounted_cash":61.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMINO ACIDS QN CSF 80137","code_information":[{"code":"82139","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":121.9,"maximum":187.91,"gross_charge":230,"discounted_cash":52.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMINO ACIDS QN CSF 80137","code_information":[{"code":"82139","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.12,"maximum":187.91,"gross_charge":230,"discounted_cash":52.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMINO ACIDS QN P 2009389","code_information":[{"code":"82139","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMINO ACIDS QN P 2009389","code_information":[{"code":"82139","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.12,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMINO ACIDS QN U 2009419","code_information":[{"code":"82139","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":109.71,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMINO ACIDS QN U 2009419","code_information":[{"code":"82139","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.12,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"AMMONIA","code_information":[{"code":"82140","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":174.9,"maximum":269.61,"gross_charge":330,"discounted_cash":75.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.61,"methodology":"fee schedule"}]}]},{"description":"AMMONIA","code_information":[{"code":"82140","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.74,"maximum":269.61,"gross_charge":330,"discounted_cash":75.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"}]}]},{"description":"AMYLASE","code_information":[{"code":"82150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":149.99,"maximum":231.22,"gross_charge":283,"discounted_cash":64.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":231.22,"methodology":"fee schedule"}]}]},{"description":"AMYLASE","code_information":[{"code":"82150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.88,"maximum":231.22,"gross_charge":283,"discounted_cash":64.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":231.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMYLASE ISOENZYMES 20804","code_information":[{"code":"82150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.2,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMYLASE ISOENZYMES 20804","code_information":[{"code":"82150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.88,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANDROSTENEDIONE 2001638","code_information":[{"code":"82157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":95.93,"maximum":147.88,"gross_charge":181,"discounted_cash":41.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANDROSTENEDIONE 2001638","code_information":[{"code":"82157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.56,"maximum":147.88,"gross_charge":181,"discounted_cash":41.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANGIOTENSIN II PLASM98771","code_information":[{"code":"82163","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":255.46,"maximum":393.8,"gross_charge":482,"discounted_cash":110.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":255.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":393.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANGIOTENSIN II PLASM98771","code_information":[{"code":"82163","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.31,"maximum":393.8,"gross_charge":482,"discounted_cash":110.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":255.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":393.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANGIOTENSIN CONV CSF98974","code_information":[{"code":"82164","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANGIOTENSIN CONV CSF98974","code_information":[{"code":"82164","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.76,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANGIOTENSIN CONV S 80001","code_information":[{"code":"82164","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":104.41,"maximum":160.95,"gross_charge":197,"discounted_cash":45.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANGIOTENSIN CONV S 80001","code_information":[{"code":"82164","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.76,"maximum":160.95,"gross_charge":197,"discounted_cash":45.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIMULLERIAN HORM2002656","code_information":[{"code":"82166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":39.75,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIMULLERIAN HORM2002656","code_information":[{"code":"82166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.17,"maximum":187.94,"gross_charge":75,"discounted_cash":17.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-APOLIPOPROTEIN A-1 50030","code_information":[{"code":"82172","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.41,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-APOLIPOPROTEIN A-1 50030","code_information":[{"code":"82172","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.65,"maximum":102.63,"gross_charge":97,"discounted_cash":22.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":61.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-APOLIPOPROTEIN B 50029","code_information":[{"code":"82172","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.2,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-APOLIPOPROTEIN B 50029","code_information":[{"code":"82172","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.65,"maximum":102.63,"gross_charge":40,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":61.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-ARSENIC 20584B","code_information":[{"code":"82175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":221.01,"maximum":340.69,"gross_charge":417,"discounted_cash":95.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":221.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":340.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-ARSENIC 20584B","code_information":[{"code":"82175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.38,"maximum":340.69,"gross_charge":417,"discounted_cash":95.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":55.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":221.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":340.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-ARSENIC 99470A","code_information":[{"code":"82175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":62.01,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-ARSENIC 99470A","code_information":[{"code":"82175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.38,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":55.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-ARSENIC 99475A","code_information":[{"code":"82175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":224.19,"maximum":345.6,"gross_charge":423,"discounted_cash":96.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":224.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":345.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-ARSENIC 99475A","code_information":[{"code":"82175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.38,"maximum":345.6,"gross_charge":423,"discounted_cash":96.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":55.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":224.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":345.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN C PLASMA 80380","code_information":[{"code":"82180","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.55,"maximum":28.6,"gross_charge":35,"discounted_cash":8.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN C PLASMA 80380","code_information":[{"code":"82180","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.93,"maximum":48.17,"gross_charge":35,"discounted_cash":8.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"}]}]},{"description":"HEMO/HOME/SUPPL","code_information":[{"code":"822","type":"RC"}],"standard_charges":[{"minimum":22.51,"maximum":1026,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1026,"methodology":"case rate"}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"minimum":10117.55,"maximum":76602.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23751,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23751,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76602.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57452.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57452.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22980.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18950.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26084.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10117.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10218.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10421.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10319.91,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10117.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10117.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10117.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10370.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10117.55,"methodology":"case rate"}]}]},{"description":"RL-A-BETA-2 MICROGLOB S/P80053","code_information":[{"code":"82232","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":53,"maximum":81.7,"gross_charge":100,"discounted_cash":22.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-2 MICROGLOB S/P80053","code_information":[{"code":"82232","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.7,"maximum":81.7,"gross_charge":100,"discounted_cash":22.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-2-MICROGLOB UR 80432","code_information":[{"code":"82232","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.88,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-2-MICROGLOB UR 80432","code_information":[{"code":"82232","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.7,"maximum":78.73,"gross_charge":96,"discounted_cash":21.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILE ACIDS TOTAL 70189","code_information":[{"code":"82239","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILE ACIDS TOTAL 70189","code_information":[{"code":"82239","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.27,"maximum":83.31,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"}]}]},{"description":"BILIRUBIN TOTAL","code_information":[{"code":"82247","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"BILIRUBIN TOTAL","code_information":[{"code":"82247","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.01,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"}]}]},{"description":"BILIRUBIN DIRECT","code_information":[{"code":"82248","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":103.88,"maximum":160.14,"gross_charge":196,"discounted_cash":44.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"}]}]},{"description":"BILIRUBIN DIRECT","code_information":[{"code":"82248","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.01,"maximum":160.14,"gross_charge":196,"discounted_cash":44.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-BIOTINIDASE SERUM 93362","code_information":[{"code":"82261","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":70.49,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-BIOTINIDASE SERUM 93362","code_information":[{"code":"82261","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.12,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"OCCULT BLOOD OTHER QL","code_information":[{"code":"82271","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.89,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"}]}]},{"description":"OCCULT BLOOD OTHER QL","code_information":[{"code":"82271","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.19,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"}]}]},{"description":"OCCULT BLOOD FECES QL","code_information":[{"code":"82272","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":67.84,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"OCCULT BLOOD FECES QL","code_information":[{"code":"82272","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.53,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"}]}]},{"description":"FECAL BLOOD IMMUNOASSAY QL","code_information":[{"code":"82274","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.94,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"}]}]},{"description":"FECAL BLOOD IMMUNOASSAY QL","code_information":[{"code":"82274","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.55,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"}]}]},{"description":"HEMODIALYSIS","code_information":[{"code":"823","type":"RC"}],"standard_charges":[{"minimum":846,"maximum":1026,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1026,"methodology":"case rate"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"minimum":37459.96,"maximum":87269.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79464,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79464,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54780.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41086.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41086.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":76883.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63402.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":87269.02,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37459.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":37834.56,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38583.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38209.16,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37459.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37459.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37459.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38396.46,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37459.96,"methodology":"case rate"}]}]},{"description":"RL-A-CADMIUM 20584A","code_information":[{"code":"82300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-CADMIUM 20584A","code_information":[{"code":"82300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.18,"maximum":115.08,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":69.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-CADMIUM BLOOD 99675","code_information":[{"code":"82300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":71.55,"maximum":110.3,"gross_charge":135,"discounted_cash":30.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-CADMIUM BLOOD 99675","code_information":[{"code":"82300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.18,"maximum":115.08,"gross_charge":135,"discounted_cash":30.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":69.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-CADMIUM URINE 25040","code_information":[{"code":"82300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-CADMIUM URINE 25040","code_information":[{"code":"82300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.18,"maximum":115.08,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":69.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-25HYDROXY D2D3 TMS2002348","code_information":[{"code":"82306","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":79.5,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-25HYDROXY D2D3 TMS2002348","code_information":[{"code":"82306","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.76,"maximum":144.07,"gross_charge":150,"discounted_cash":34.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":86.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"}]}]},{"description":"VITAMIN D 25 HYDROXY","code_information":[{"code":"82306","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":173.84,"maximum":267.98,"gross_charge":328,"discounted_cash":75.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":173.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":267.98,"methodology":"fee schedule"}]}]},{"description":"VITAMIN D 25 HYDROXY","code_information":[{"code":"82306","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.76,"maximum":267.98,"gross_charge":328,"discounted_cash":75.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":86.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":173.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":267.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-CALCITONIN 70006","code_information":[{"code":"82308","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.98,"maximum":135.63,"gross_charge":166,"discounted_cash":38.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-CALCITONIN 70006","code_information":[{"code":"82308","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.07,"maximum":135.63,"gross_charge":166,"discounted_cash":38.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":130.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.79,"methodology":"fee schedule"}]}]},{"description":"CALCIUM TOTAL SERUM/FLUID","code_information":[{"code":"82310","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"CALCIUM TOTAL SERUM/FLUID","code_information":[{"code":"82310","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.09,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"}]}]},{"description":"CALCIUM URINE RANDOM","code_information":[{"code":"82310","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":52.47,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"}]}]},{"description":"CALCIUM URINE RANDOM","code_information":[{"code":"82310","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.09,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-CALCIUM TOTAL 70172A","code_information":[{"code":"82310","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-CALCIUM TOTAL 70172A","code_information":[{"code":"82310","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.09,"maximum":25.12,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"}]}]},{"description":"CALCIUM IONIZED","code_information":[{"code":"82330","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":130.91,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"}]}]},{"description":"CALCIUM IONIZED","code_information":[{"code":"82330","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.2,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"}]}]},{"description":"CALCIUM URINE QN 24HR","code_information":[{"code":"82340","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":88.51,"maximum":136.44,"gross_charge":167,"discounted_cash":38.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.44,"methodology":"fee schedule"}]}]},{"description":"CALCIUM URINE QN 24HR","code_information":[{"code":"82340","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.61,"maximum":136.44,"gross_charge":167,"discounted_cash":38.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-CALCULI ANALYSIS 99460","code_information":[{"code":"82365","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-CALCULI ANALYSIS 99460","code_information":[{"code":"82365","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.74,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-CDT ALCOHOL USE 70412","code_information":[{"code":"82373","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.65,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-CDT ALCOHOL USE 70412","code_information":[{"code":"82373","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.83,"maximum":87.89,"gross_charge":105,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"}]}]},{"description":"CARBON DIOXIDE (BICARB)","code_information":[{"code":"82374","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":46.11,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"}]}]},{"description":"CARBON DIOXIDE (BICARB)","code_information":[{"code":"82374","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.92,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-BICARBONATE URINE 20245","code_information":[{"code":"82374","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-BICARBONATE URINE 20245","code_information":[{"code":"82374","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.92,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"}]}]},{"description":"CARBOXYHEMOGLOBIN QUANT","code_information":[{"code":"82375","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":125.61,"maximum":193.63,"gross_charge":237,"discounted_cash":54.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.63,"methodology":"fee schedule"}]}]},{"description":"CARBOXYHEMOGLOBIN QUANT","code_information":[{"code":"82375","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.39,"maximum":193.63,"gross_charge":237,"discounted_cash":54.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"}]}]},{"description":"CARCINOEMBRYONIC AG (CEA)","code_information":[{"code":"82378","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":242.21,"maximum":373.37,"gross_charge":457,"discounted_cash":104.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":242.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.37,"methodology":"fee schedule"}]}]},{"description":"CARCINOEMBRYONIC AG (CEA)","code_information":[{"code":"82378","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.37,"maximum":373.37,"gross_charge":457,"discounted_cash":104.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":242.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARCINOEMBRYO AG FL 20742","code_information":[{"code":"82378","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":214.12,"maximum":330.07,"gross_charge":404,"discounted_cash":92.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":214.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARCINOEMBRYO AG FL 20742","code_information":[{"code":"82378","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.37,"maximum":330.07,"gross_charge":404,"discounted_cash":92.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":214.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARNITINE FREE TOT 80068","code_information":[{"code":"82379","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":46.11,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARNITINE FREE TOT 80068","code_information":[{"code":"82379","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.12,"maximum":82.09,"gross_charge":87,"discounted_cash":19.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-CAROTENE SERUM TOT 80055","code_information":[{"code":"82380","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":213.06,"maximum":328.44,"gross_charge":402,"discounted_cash":92.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":213.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":328.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-CAROTENE SERUM TOT 80055","code_information":[{"code":"82380","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.53,"maximum":328.44,"gross_charge":402,"discounted_cash":92.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":213.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":328.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-CATECHOLAMINES FRAC 80216","code_information":[{"code":"82384","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":74.73,"maximum":115.2,"gross_charge":141,"discounted_cash":32.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-CATECHOLAMINES FRAC 80216","code_information":[{"code":"82384","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.15,"maximum":122.89,"gross_charge":141,"discounted_cash":32.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":73.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-CERULOPLASMIN 50160","code_information":[{"code":"82390","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.98,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-CERULOPLASMIN 50160","code_information":[{"code":"82390","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.44,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-IGF BIND PROTEIN-3 70060","code_information":[{"code":"82397","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-IGF BIND PROTEIN-3 70060","code_information":[{"code":"82397","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.47,"maximum":68.71,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"}]}]},{"description":"HEMODIALYSIS","code_information":[{"code":"824","type":"RC"}],"standard_charges":[{"minimum":846,"maximum":1026,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1026,"methodology":"case rate"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"minimum":18281.3,"maximum":47966.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43677,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43677,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35267.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26451.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26451.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":42258.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34848.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47966.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18281.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18464.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18829.74,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18646.93,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18281.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18281.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18281.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18738.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18281.3,"methodology":"case rate"}]}]},{"description":"CHLORIDE BLOOD","code_information":[{"code":"82435","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"CHLORIDE BLOOD","code_information":[{"code":"82435","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.76,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"}]}]},{"description":"CHLORIDE URINE","code_information":[{"code":"82436","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":73.14,"maximum":112.75,"gross_charge":138,"discounted_cash":31.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.75,"methodology":"fee schedule"}]}]},{"description":"CHLORIDE URINE","code_information":[{"code":"82436","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.45,"maximum":112.75,"gross_charge":138,"discounted_cash":31.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHLORIDE FLUID 20163","code_information":[{"code":"82438","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHLORIDE FLUID 20163","code_information":[{"code":"82438","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3,"maximum":24.33,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHLORIDE OTHER SRC 60185A","code_information":[{"code":"82438","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.6,"maximum":16.34,"gross_charge":20,"discounted_cash":4.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHLORIDE OTHER SRC 60185A","code_information":[{"code":"82438","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3,"maximum":24.33,"gross_charge":20,"discounted_cash":4.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"}]}]},{"description":"CHOLESTEROL TOTAL","code_information":[{"code":"82465","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":32.86,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"}]}]},{"description":"CHOLESTEROL TOTAL","code_information":[{"code":"82465","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.61,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHOLINESTERASE SER 20159A","code_information":[{"code":"82480","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.44,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHOLINESTERASE SER 20159A","code_information":[{"code":"82480","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.72,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-PSEUDOCHOLINEST TOT 20167","code_information":[{"code":"82480","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":57.24,"maximum":88.24,"gross_charge":108,"discounted_cash":24.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"}]}]},{"description":"RL-A-PSEUDOCHOLINEST TOT 20167","code_information":[{"code":"82480","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.72,"maximum":88.24,"gross_charge":108,"discounted_cash":24.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHOLINESTERASE RBC 20174","code_information":[{"code":"82482","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":38.4,"gross_charge":47,"discounted_cash":10.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHOLINESTERASE RBC 20174","code_information":[{"code":"82482","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.88,"maximum":47.74,"gross_charge":47,"discounted_cash":10.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROMIUM SERUM 98830","code_information":[{"code":"82495","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":66.25,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROMIUM SERUM 98830","code_information":[{"code":"82495","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.16,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":59.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"}]}]},{"description":"HEMO/HOME/SUPSERV","code_information":[{"code":"825","type":"RC"}],"standard_charges":[{"minimum":846,"maximum":1866.01,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1866.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1399.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1399.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1026,"methodology":"case rate"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"minimum":10791.1,"maximum":103355.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25444,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25444,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103355.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77518.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77518.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24618.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20301.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27943.33,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10791.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10899.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11114.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11006.93,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10791.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10791.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10791.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11060.88,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10791.1,"methodology":"case rate"}]}]},{"description":"RL-A-CITRIC ACID URINE 20852","code_information":[{"code":"82507","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":91.16,"maximum":140.53,"gross_charge":172,"discounted_cash":39.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-CITRIC ACID URINE 20852","code_information":[{"code":"82507","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.68,"maximum":140.53,"gross_charge":172,"discounted_cash":39.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":81.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-C-TELOPEPTIDE SERUM 70416","code_information":[{"code":"82523","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.36,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-C-TELOPEPTIDE SERUM 70416","code_information":[{"code":"82523","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.2,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-N-TELOP CROSSLINK S 70500","code_information":[{"code":"82523","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-N-TELOP CROSSLINK S 70500","code_information":[{"code":"82523","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.2,"maximum":90.89,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-N-TELOP CROSSLINK U 70062","code_information":[{"code":"82523","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":124.02,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-N-TELOP CROSSLINK U 70062","code_information":[{"code":"82523","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.2,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-COPPER LIVER 20694","code_information":[{"code":"82525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":30.21,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-COPPER LIVER 20694","code_information":[{"code":"82525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.44,"maximum":60.41,"gross_charge":57,"discounted_cash":13.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"}]}]},{"description":"RL-A-COPPER SERUM/PLASMA 20096","code_information":[{"code":"82525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":40.28,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-COPPER SERUM/PLASMA 20096","code_information":[{"code":"82525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.44,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"}]}]},{"description":"RL-A-CORTISOL FREE EQU 2012697","code_information":[{"code":"82530","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-CORTISOL FREE EQU 2012697","code_information":[{"code":"82530","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.02,"maximum":81.3,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-CORTISOL URINE FREE 97222","code_information":[{"code":"82530","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":54.59,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-CORTISOL URINE FREE 97222","code_information":[{"code":"82530","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.02,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"}]}]},{"description":"CORTISOL TOTAL","code_information":[{"code":"82533","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":210.94,"maximum":325.17,"gross_charge":398,"discounted_cash":91.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":210.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":325.17,"methodology":"fee schedule"}]}]},{"description":"CORTISOL TOTAL","code_information":[{"code":"82533","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.78,"maximum":325.17,"gross_charge":398,"discounted_cash":91.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":210.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":325.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-CORTIS LCMSMS SAL 3016866","code_information":[{"code":"82533","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.51,"maximum":54.74,"gross_charge":67,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-CORTIS LCMSMS SAL 3016866","code_information":[{"code":"82533","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.78,"maximum":79.3,"gross_charge":67,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-CORTISOL SALIVA 81117","code_information":[{"code":"82533","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":191.86,"maximum":295.76,"gross_charge":362,"discounted_cash":82.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":191.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":295.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-CORTISOL SALIVA 81117","code_information":[{"code":"82533","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.78,"maximum":295.76,"gross_charge":362,"discounted_cash":82.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":191.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":295.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-CREATINE SRM/PLSM 2002340","code_information":[{"code":"82540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":43.99,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-CREATINE SRM/PLSM 2002340","code_information":[{"code":"82540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.78,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"}]}]},{"description":"COL CHROMOTOGRAP QL/QN EA SPEC","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":385.31,"maximum":593.96,"gross_charge":727,"discounted_cash":166.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":385.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":593.96,"methodology":"fee schedule"}]}]},{"description":"COL CHROMOTOGRAP QL/QN EA SPEC","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.45,"maximum":593.96,"gross_charge":727,"discounted_cash":166.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":385.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":593.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-COENZYME Q10 TOTAL 81119","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.65,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-COENZYME Q10 TOTAL 81119","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.45,"maximum":117.23,"gross_charge":105,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-PTHRP LC MS/MS P 2010677","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.98,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-PTHRP LC MS/MS P 2010677","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.45,"maximum":117.23,"gross_charge":66,"discounted_cash":15.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"}]}]},{"description":"RL-M-MASS SPECTROMETRY","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":106.53,"maximum":164.22,"gross_charge":201,"discounted_cash":46.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.22,"methodology":"fee schedule"}]}]},{"description":"RL-M-MASS SPECTROMETRY","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.45,"maximum":164.22,"gross_charge":201,"discounted_cash":46.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"}]}]},{"description":"CREATINE KINASE (CPK) QW","code_information":[{"code":"82550","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.78,"maximum":21.25,"gross_charge":26,"discounted_cash":5.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"}]}]},{"description":"CREATINE KINASE (CPK) QW","code_information":[{"code":"82550","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.9,"maximum":31.71,"gross_charge":26,"discounted_cash":5.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"}]}]},{"description":"CREATINE KINASE (CPK) TOTAL","code_information":[{"code":"82550","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":128.26,"maximum":197.72,"gross_charge":242,"discounted_cash":55.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197.72,"methodology":"fee schedule"}]}]},{"description":"CREATINE KINASE (CPK) TOTAL","code_information":[{"code":"82550","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.9,"maximum":197.72,"gross_charge":242,"discounted_cash":55.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-CPK TOTAL 20414A","code_information":[{"code":"82550","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.6,"maximum":16.34,"gross_charge":20,"discounted_cash":4.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-CPK TOTAL 20414A","code_information":[{"code":"82550","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.9,"maximum":31.71,"gross_charge":20,"discounted_cash":4.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-CPK ISOENZYMES 20414B","code_information":[{"code":"82552","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-CPK ISOENZYMES 20414B","code_information":[{"code":"82552","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.03,"maximum":65.2,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"}]}]},{"description":"CREATINE KINASE (CPK) MB ONLY","code_information":[{"code":"82553","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"CREATINE KINASE (CPK) MB ONLY","code_information":[{"code":"82553","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.93,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"}]}]},{"description":"CREATININE BLOOD","code_information":[{"code":"82565","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"CREATININE BLOOD","code_information":[{"code":"82565","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.07,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"}]}]},{"description":"CREATININE BLOOD QW","code_information":[{"code":"82565","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.6,"maximum":16.34,"gross_charge":20,"discounted_cash":4.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"CREATININE BLOOD QW","code_information":[{"code":"82565","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.07,"maximum":24.91,"gross_charge":20,"discounted_cash":4.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-CREATININE BLOOD 3018316B","code_information":[{"code":"82565","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.86,"maximum":16.74,"gross_charge":20.48,"discounted_cash":4.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-CREATININE BLOOD 3018316B","code_information":[{"code":"82565","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.07,"maximum":24.91,"gross_charge":20.48,"discounted_cash":4.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"}]}]},{"description":"CREATININE OTHER SOURCE","code_information":[{"code":"82570","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.69,"maximum":59.65,"gross_charge":73,"discounted_cash":16.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"}]}]},{"description":"CREATININE OTHER SOURCE","code_information":[{"code":"82570","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":59.65,"gross_charge":73,"discounted_cash":16.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-CREATININE OTH SRC 50203B","code_information":[{"code":"82570","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":17.16,"gross_charge":21,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-CREATININE OTH SRC 50203B","code_information":[{"code":"82570","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":25.19,"gross_charge":21,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"CREATININE CLEARANCE","code_information":[{"code":"82575","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"CREATININE CLEARANCE","code_information":[{"code":"82575","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.67,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-CRYOFIBRINOGEN 50190","code_information":[{"code":"82585","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":73.14,"maximum":112.75,"gross_charge":138,"discounted_cash":31.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-CRYOFIBRINOGEN 50190","code_information":[{"code":"82585","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.48,"maximum":112.75,"gross_charge":138,"discounted_cash":31.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"}]}]},{"description":"CRYOGLOBULIN QUAL OR SEMIQUANT","code_information":[{"code":"82595","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.98,"maximum":135.63,"gross_charge":166,"discounted_cash":38.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.63,"methodology":"fee schedule"}]}]},{"description":"CRYOGLOBULIN QUAL OR SEMIQUANT","code_information":[{"code":"82595","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.88,"maximum":135.63,"gross_charge":166,"discounted_cash":38.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"minimum":38202.33,"maximum":103459.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94206,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94206,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62952.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47215.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47215.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":91147.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":75164.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":103459.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38202.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38584.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39348.4,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38966.38,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38202.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38202.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38202.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39157.39,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38202.33,"methodology":"case rate"}]}]},{"description":"RL-A-CYANIDE WHOLE BLD 3003039","code_information":[{"code":"82600","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":180.2,"maximum":277.78,"gross_charge":340,"discounted_cash":77.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":180.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYANIDE WHOLE BLD 3003039","code_information":[{"code":"82600","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.64,"maximum":277.78,"gross_charge":340,"discounted_cash":77.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":180.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"}]}]},{"description":"VITAMIN B-12","code_information":[{"code":"82607","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":160.59,"maximum":247.56,"gross_charge":303,"discounted_cash":69.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":160.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.56,"methodology":"fee schedule"}]}]},{"description":"VITAMIN B-12","code_information":[{"code":"82607","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.04,"maximum":247.56,"gross_charge":303,"discounted_cash":69.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":160.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYSTATIN C 3018316A","code_information":[{"code":"82610","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.36,"maximum":57.59,"gross_charge":70.48,"discounted_cash":16.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYSTATIN C 3018316A","code_information":[{"code":"82610","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.11,"maximum":90.11,"gross_charge":70.48,"discounted_cash":16.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-DEHYDROEPIAND SP 2001640","code_information":[{"code":"82626","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":83.21,"maximum":128.27,"gross_charge":157,"discounted_cash":35.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-DEHYDROEPIAND SP 2001640","code_information":[{"code":"82626","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.16,"maximum":128.27,"gross_charge":157,"discounted_cash":35.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":73.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"}]}]},{"description":"DHEA-S","code_information":[{"code":"82627","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":102.29,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"}]}]},{"description":"DHEA-S","code_information":[{"code":"82627","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.33,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":65.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-11DEOXYCORT QN SP 2008458","code_information":[{"code":"82633","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":67.84,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-11DEOXYCORT QN SP 2008458","code_information":[{"code":"82633","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.58,"maximum":150.8,"gross_charge":128,"discounted_cash":29.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":64.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":64.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-11 DEOXYCORT QN SP 92331","code_information":[{"code":"82634","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":95.93,"maximum":147.88,"gross_charge":181,"discounted_cash":41.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-11 DEOXYCORT QN SP 92331","code_information":[{"code":"82634","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.56,"maximum":147.88,"gross_charge":181,"discounted_cash":41.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-DIBUCAINE NUMBER 20159B","code_information":[{"code":"82638","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":39.75,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-DIBUCAINE NUMBER 20159B","code_information":[{"code":"82638","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.35,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-5A-DIHYDROTESTOST 2002349","code_information":[{"code":"82642","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":84.8,"maximum":130.72,"gross_charge":160,"discounted_cash":36.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-5A-DIHYDROTESTOST 2002349","code_information":[{"code":"82642","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.56,"maximum":142.5,"gross_charge":160,"discounted_cash":36.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-VIT D1 25-DIHYDROXY 80385","code_information":[{"code":"82652","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":187.62,"maximum":289.22,"gross_charge":354,"discounted_cash":81.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-VIT D1 25-DIHYDROXY 80385","code_information":[{"code":"82652","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.1,"maximum":289.22,"gross_charge":354,"discounted_cash":81.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":103.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":103.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":112.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":39.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-PANCREAT ELASTASE 3002858","code_information":[{"code":"82653","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":36.62,"maximum":56.44,"gross_charge":69.08,"discounted_cash":15.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-PANCREAT ELASTASE 3002858","code_information":[{"code":"82653","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.78,"maximum":111.79,"gross_charge":69.08,"discounted_cash":15.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.78,"methodology":"fee schedule"}]}]},{"description":"ENZYME CELL ACTIVITY","code_information":[{"code":"82657","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":111.3,"maximum":171.57,"gross_charge":210,"discounted_cash":48.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.57,"methodology":"fee schedule"}]}]},{"description":"ENZYME CELL ACTIVITY","code_information":[{"code":"82657","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.3,"maximum":171.57,"gross_charge":210,"discounted_cash":48.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":64.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-PBG DEAMINASE ERYTHR99550","code_information":[{"code":"82657","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":102.82,"maximum":158.5,"gross_charge":194,"discounted_cash":44.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-PBG DEAMINASE ERYTHR99550","code_information":[{"code":"82657","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.3,"maximum":158.5,"gross_charge":194,"discounted_cash":44.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":64.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"}]}]},{"description":"ENZYME CELL ACTIVITY RA","code_information":[{"code":"82658","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":640.24,"maximum":986.94,"gross_charge":1208,"discounted_cash":276.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":640.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":986.94,"methodology":"fee schedule"}]}]},{"description":"ENZYME CELL ACTIVITY RA","code_information":[{"code":"82658","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.41,"maximum":986.94,"gross_charge":1208,"discounted_cash":276.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":640.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":986.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":44.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":45.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-ERYTHROPOIETIN 50227","code_information":[{"code":"82668","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-ERYTHROPOIETIN 50227","code_information":[{"code":"82668","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.27,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.79,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL TOTAL","code_information":[{"code":"82670","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":181.26,"maximum":279.42,"gross_charge":342,"discounted_cash":78.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":181.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":279.42,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL TOTAL","code_information":[{"code":"82670","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.76,"maximum":279.42,"gross_charge":342,"discounted_cash":78.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":81.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":181.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":279.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-ESTROGENS FRACTION 93248","code_information":[{"code":"82671","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":149.46,"maximum":230.4,"gross_charge":282,"discounted_cash":64.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-ESTROGENS FRACTION 93248","code_information":[{"code":"82671","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.38,"maximum":230.4,"gross_charge":282,"discounted_cash":64.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":94.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-ESTRIOL SERUM 70051","code_information":[{"code":"82677","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":74.73,"maximum":115.2,"gross_charge":141,"discounted_cash":32.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-ESTRIOL SERUM 70051","code_information":[{"code":"82677","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.5,"maximum":117.66,"gross_charge":141,"discounted_cash":32.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-ESTRONE BY TMS SP 93249","code_information":[{"code":"82679","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":33.92,"maximum":52.29,"gross_charge":64,"discounted_cash":14.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-ESTRONE BY TMS SP 93249","code_information":[{"code":"82679","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.97,"maximum":121.45,"gross_charge":64,"discounted_cash":14.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":72.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-ETHYLENE GLYCOL 90110","code_information":[{"code":"82693","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-ETHYLENE GLYCOL 90110","code_information":[{"code":"82693","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.94,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"minimum":19522.45,"maximum":47783.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43509,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43509,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39254.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29441.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29441.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":42096.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34715.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47783.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19522.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19717.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20108.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19912.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19522.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19522.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19522.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20010.52,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19522.45,"methodology":"case rate"}]}]},{"description":"RL-A-FAT FECAL QL 20385","code_information":[{"code":"82705","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":234.4,"maximum":361.33,"gross_charge":442.26,"discounted_cash":101.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":234.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":361.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAT FECAL QL 20385","code_information":[{"code":"82705","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.06,"maximum":361.33,"gross_charge":442.26,"discounted_cash":101.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":234.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":361.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAT FECAL QN 24HR 2002354","code_information":[{"code":"82710","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":322.24,"maximum":496.74,"gross_charge":608,"discounted_cash":139.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":496.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAT FECAL QN 24HR 2002354","code_information":[{"code":"82710","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.08,"maximum":496.74,"gross_charge":608,"discounted_cash":139.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":496.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAT FECAL QN 48HR 2002355","code_information":[{"code":"82710","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":312.7,"maximum":482.03,"gross_charge":590,"discounted_cash":135.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":312.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":482.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAT FECAL QN 48HR 2002355","code_information":[{"code":"82710","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.08,"maximum":482.03,"gross_charge":590,"discounted_cash":135.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":312.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":482.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAT FECAL QN 72HR 2002356","code_information":[{"code":"82710","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":311.11,"maximum":479.58,"gross_charge":587,"discounted_cash":134.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":311.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":479.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAT FECAL QN 72HR 2002356","code_information":[{"code":"82710","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.08,"maximum":479.58,"gross_charge":587,"discounted_cash":134.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":311.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":479.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-FATTY ACIDS FREE 80120","code_information":[{"code":"82725","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-FATTY ACIDS FREE 80120","code_information":[{"code":"82725","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.26,"maximum":91.32,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-VERY LONG FAT ACID2004250","code_information":[{"code":"82726","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":179.14,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-VERY LONG FAT ACID2004250","code_information":[{"code":"82726","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.85,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"}]}]},{"description":"FERRITIN","code_information":[{"code":"82728","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":158.47,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"}]}]},{"description":"FERRITIN","code_information":[{"code":"82728","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.17,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"}]}]},{"description":"FETAL FIBRONECTIN","code_information":[{"code":"82731","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":413.93,"maximum":638.08,"gross_charge":781,"discounted_cash":178.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":413.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":638.08,"methodology":"fee schedule"}]}]},{"description":"FETAL FIBRONECTIN","code_information":[{"code":"82731","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.64,"maximum":638.08,"gross_charge":781,"discounted_cash":178.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":133.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":133.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":188.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":413.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":638.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":65.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":66.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":65.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":66.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID SERUM","code_information":[{"code":"82746","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":127.2,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID SERUM","code_information":[{"code":"82746","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.82,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"}]}]},{"description":"GAMMAGLOBULIN IGA SERUM","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":77.91,"maximum":120.1,"gross_charge":147,"discounted_cash":33.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.1,"methodology":"fee schedule"}]}]},{"description":"GAMMAGLOBULIN IGA SERUM","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.58,"maximum":120.1,"gross_charge":147,"discounted_cash":33.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-CELIAC RFLX CASCAD2008114","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.61,"maximum":30.23,"gross_charge":37,"discounted_cash":8.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-CELIAC RFLX CASCAD2008114","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.58,"maximum":45.23,"gross_charge":37,"discounted_cash":8.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMAGLOBULIN 50676C","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.49,"maximum":26.97,"gross_charge":33,"discounted_cash":7.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMAGLOBULIN 50676C","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.58,"maximum":45.23,"gross_charge":33,"discounted_cash":7.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMAGLOBULIN 93149A","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMAGLOBULIN 93149A","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.58,"maximum":45.23,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOGLOBULIN G 50350","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOGLOBULIN G 50350","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.58,"maximum":45.23,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOGLOBULIN M 50355","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.19,"maximum":18.8,"gross_charge":23,"discounted_cash":5.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOGLOBULIN M 50355","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.58,"maximum":45.23,"gross_charge":23,"discounted_cash":5.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"}]}]},{"description":"GAMMAGLOBULIN IGE","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":171.19,"maximum":263.9,"gross_charge":323,"discounted_cash":73.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.9,"methodology":"fee schedule"}]}]},{"description":"GAMMAGLOBULIN IGE","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.87,"maximum":263.9,"gross_charge":323,"discounted_cash":73.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMABLOGULIN IGE 50486A","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMABLOGULIN IGE 50486A","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.87,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMABLOGULIN IGE 50529B","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":310.05,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMABLOGULIN IGE 50529B","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.87,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMABLOGULN IGE 3001721B","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.98,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAMMABLOGULN IGE 3001721B","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.87,"maximum":80.09,"gross_charge":66,"discounted_cash":15.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOGLOBULIN E 50345","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":49.29,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOGLOBULIN E 50345","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.87,"maximum":80.09,"gross_charge":93,"discounted_cash":21.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-IGG 1 2 3 OR 4 EA 93149B","code_information":[{"code":"82787","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-IGG 1 2 3 OR 4 EA 93149B","code_information":[{"code":"82787","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.81,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-IGG SUBCLASS 4 50576","code_information":[{"code":"82787","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-IGG SUBCLASS 4 50576","code_information":[{"code":"82787","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.81,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"minimum":13668.56,"maximum":50409.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31017,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31017,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50409.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37807.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37807.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30010.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24748.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34064.25,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13668.56,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13805.25,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14078.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13941.94,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13668.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13668.56,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13668.56,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14010.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13668.56,"methodology":"case rate"}]}]},{"description":"BLOOD GAS PH PCO2 PO2 LAB","code_information":[{"code":"82803","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":189.21,"maximum":291.67,"gross_charge":357,"discounted_cash":81.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.67,"methodology":"fee schedule"}]}]},{"description":"BLOOD GAS PH PCO2 PO2 LAB","code_information":[{"code":"82803","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.64,"maximum":291.67,"gross_charge":357,"discounted_cash":81.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"}]}]},{"description":"BLOOD GAS O2 SAT ONLY","code_information":[{"code":"82810","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":65.19,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"}]}]},{"description":"BLOOD GAS O2 SAT ONLY","code_information":[{"code":"82810","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.86,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"}]}]},{"description":"HEMO/HOME/OTHER","code_information":[{"code":"829","type":"RC"}],"standard_charges":[{"minimum":486.45,"maximum":1026,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":486.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":486.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1026,"methodology":"case rate"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"minimum":24901.51,"maximum":64776.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58983,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58983,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33201.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24901.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24901.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":57067.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47060.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64776.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25120.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25371.59,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25874,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25622.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25120.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25120.38,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25120.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25748.39,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25120.38,"methodology":"case rate"}]}]},{"description":"RL-A-GASTRIN 70075","code_information":[{"code":"82941","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-GASTRIN 70075","code_information":[{"code":"82941","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.57,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":51.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-GLUCAGON 99165","code_information":[{"code":"82943","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":47.17,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-GLUCAGON 99165","code_information":[{"code":"82943","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.57,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE BODY FLUID","code_information":[{"code":"82945","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.45,"maximum":134.81,"gross_charge":165,"discounted_cash":37.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":134.81,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE BODY FLUID","code_information":[{"code":"82945","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.35,"maximum":134.81,"gross_charge":165,"discounted_cash":37.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":134.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE BLOOD","code_information":[{"code":"82947","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE BLOOD","code_information":[{"code":"82947","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.35,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE BLOOD QW","code_information":[{"code":"82947","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.48,"maximum":13.08,"gross_charge":16,"discounted_cash":3.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE BLOOD QW","code_information":[{"code":"82947","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.35,"maximum":19.11,"gross_charge":16,"discounted_cash":3.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE POST DOSE","code_information":[{"code":"82950","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE POST DOSE","code_information":[{"code":"82950","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE TOLERANCE 1ST 3 SPEC","code_information":[{"code":"82951","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":171.72,"maximum":264.71,"gross_charge":324,"discounted_cash":74.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.71,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE TOLERANCE 1ST 3 SPEC","code_information":[{"code":"82951","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":264.71,"gross_charge":324,"discounted_cash":74.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE TOLERANCE ADDL SPEC","code_information":[{"code":"82952","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":71.02,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE TOLERANCE ADDL SPEC","code_information":[{"code":"82952","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.35,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"}]}]},{"description":"RL-A-GLUCOSE 6 PHOS DEHYD80135","code_information":[{"code":"82955","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-GLUCOSE 6 PHOS DEHYD80135","code_information":[{"code":"82955","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.82,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE BLOOD BY DEVICE","code_information":[{"code":"82962","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":45.05,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE BLOOD BY DEVICE","code_information":[{"code":"82962","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":1.96,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"}]}]},{"description":"GAMMA GLUTAMYLTRANSFERASE","code_information":[{"code":"82977","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":78.97,"maximum":121.74,"gross_charge":149,"discounted_cash":34.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"}]}]},{"description":"GAMMA GLUTAMYLTRANSFERASE","code_information":[{"code":"82977","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.32,"maximum":121.74,"gross_charge":149,"discounted_cash":34.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-GGT 2005661C","code_information":[{"code":"82977","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-GGT 2005661C","code_information":[{"code":"82977","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.32,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-FRUCTOSAMINE 99012","code_information":[{"code":"82985","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":20.43,"gross_charge":25,"discounted_cash":5.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-FRUCTOSAMINE 99012","code_information":[{"code":"82985","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.05,"maximum":81.59,"gross_charge":25,"discounted_cash":5.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"minimum":12582.84,"maximum":28444.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25900,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25900,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20233.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15175.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15175.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25059.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20665.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28444.64,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12582.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12708.67,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12960.33,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12834.5,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12582.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12582.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12582.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12897.42,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12582.84,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"830","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"GONADOTROPIN FSH","code_information":[{"code":"83001","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":177.02,"maximum":272.88,"gross_charge":334,"discounted_cash":76.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.88,"methodology":"fee schedule"}]}]},{"description":"GONADOTROPIN FSH","code_information":[{"code":"83001","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.14,"maximum":272.88,"gross_charge":334,"discounted_cash":76.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"}]}]},{"description":"GONADOTROPIN LUTENIZING HORM","code_information":[{"code":"83002","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":178.61,"maximum":275.33,"gross_charge":337,"discounted_cash":77.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":275.33,"methodology":"fee schedule"}]}]},{"description":"GONADOTROPIN LUTENIZING HORM","code_information":[{"code":"83002","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.11,"maximum":275.33,"gross_charge":337,"discounted_cash":77.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":275.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"}]}]},{"description":"GROWTH HORMONE (HGH)","code_information":[{"code":"83003","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":124.55,"maximum":192,"gross_charge":235,"discounted_cash":53.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192,"methodology":"fee schedule"}]}]},{"description":"GROWTH HORMONE (HGH)","code_information":[{"code":"83003","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10,"maximum":192,"gross_charge":235,"discounted_cash":53.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"}]}]},{"description":"HAPTOGLOBIN QUANTITATIVE","code_information":[{"code":"83010","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":109.71,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"}]}]},{"description":"HAPTOGLOBIN QUANTITATIVE","code_information":[{"code":"83010","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.54,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-HELICO PYL BREATH 3006271","code_information":[{"code":"83013","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":130.38,"maximum":200.99,"gross_charge":246,"discounted_cash":56.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-HELICO PYL BREATH 3006271","code_information":[{"code":"83013","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":40.41,"maximum":327.79,"gross_charge":246,"discounted_cash":56.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":327.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":327.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":139.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":139.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":197.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":69.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":68.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":69.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":67.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-COBALT SERUM/PLASMA 25037","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-COBALT SERUM/PLASMA 25037","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.17,"maximum":106.85,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":64.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-IODINE URINE 2007465","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":432.48,"maximum":666.68,"gross_charge":816,"discounted_cash":186.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":432.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":666.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-IODINE URINE 2007465","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.17,"maximum":666.68,"gross_charge":816,"discounted_cash":186.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":64.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":432.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":666.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-THALLIUM URINE 25019","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-THALLIUM URINE 25019","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.17,"maximum":106.85,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":64.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX CAP ELECTROP 2008995","code_information":[{"code":"83020","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.49,"maximum":26.97,"gross_charge":33,"discounted_cash":7.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX CAP ELECTROP 2008995","code_information":[{"code":"83020","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":62.62,"gross_charge":33,"discounted_cash":7.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-HGB EVAL CASCADE 2005792","code_information":[{"code":"83021","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-HGB EVAL CASCADE 2005792","code_information":[{"code":"83021","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.83,"maximum":87.89,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-HGB FETAL QUAL 2006848B","code_information":[{"code":"83033","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":93.28,"maximum":143.8,"gross_charge":176,"discounted_cash":40.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-HGB FETAL QUAL 2006848B","code_information":[{"code":"83033","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.8,"maximum":143.8,"gross_charge":176,"discounted_cash":40.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"}]}]},{"description":"HEMOGLOBIN GLYOSYLATED A1C","code_information":[{"code":"83036","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":108.12,"maximum":166.67,"gross_charge":204,"discounted_cash":46.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"}]}]},{"description":"HEMOGLOBIN GLYOSYLATED A1C","code_information":[{"code":"83036","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.82,"maximum":166.67,"gross_charge":204,"discounted_cash":46.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEMOGLOBIN A1C 70426","code_information":[{"code":"83036","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.6,"maximum":16.34,"gross_charge":20,"discounted_cash":4.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEMOGLOBIN A1C 70426","code_information":[{"code":"83036","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.82,"maximum":47.24,"gross_charge":20,"discounted_cash":4.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"}]}]},{"description":"HEMOGLOBIN METHEMOGLOBIN QN","code_information":[{"code":"83050","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.15,"maximum":44.94,"gross_charge":55,"discounted_cash":12.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"}]}]},{"description":"HEMOGLOBIN METHEMOGLOBIN QN","code_information":[{"code":"83050","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.92,"maximum":44.94,"gross_charge":55,"discounted_cash":12.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"}]}]},{"description":"HEMOGLOBIN PLASMA","code_information":[{"code":"83051","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.65,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"}]}]},{"description":"HEMOGLOBIN PLASMA","code_information":[{"code":"83051","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.38,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEMOGLOBIN PLASMA 20058","code_information":[{"code":"83051","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.85,"maximum":36.77,"gross_charge":45,"discounted_cash":10.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEMOGLOBIN PLASMA 20058","code_information":[{"code":"83051","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.38,"maximum":36.77,"gross_charge":45,"discounted_cash":10.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEMOSIDERIN URINE 20222","code_information":[{"code":"83070","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEMOSIDERIN URINE 20222","code_information":[{"code":"83070","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTAMINE PLASMA 70036","code_information":[{"code":"83088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTAMINE PLASMA 70036","code_information":[{"code":"83088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.71,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":86.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTAMINE URINE 70038","code_information":[{"code":"83088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":62.01,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTAMINE URINE 70038","code_information":[{"code":"83088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.71,"maximum":143.71,"gross_charge":117,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":86.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTAMINE WHOLE BLD 70037","code_information":[{"code":"83088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTAMINE WHOLE BLD 70037","code_information":[{"code":"83088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.71,"maximum":143.71,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":86.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"methodology":"fee schedule"}]}]},{"description":"HOMOCYSTEINE","code_information":[{"code":"83090","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":177.02,"maximum":272.88,"gross_charge":334,"discounted_cash":76.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.88,"methodology":"fee schedule"}]}]},{"description":"HOMOCYSTEINE","code_information":[{"code":"83090","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.75,"maximum":272.88,"gross_charge":334,"discounted_cash":76.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"}]}]},{"description":"RL-A-HOMOCYSTEINE TOTAL 99869","code_information":[{"code":"83090","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":95.4,"maximum":147.06,"gross_charge":180,"discounted_cash":41.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-HOMOCYSTEINE TOTAL 99869","code_information":[{"code":"83090","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.75,"maximum":147.06,"gross_charge":180,"discounted_cash":41.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"methodology":"fee schedule"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"minimum":9002.23,"maximum":22249.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20259,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20259,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12002.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9002.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9002.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19601.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16164.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22249.45,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10174,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10275.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10479.22,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10377.48,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10174,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10174,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10174,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10428.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10174,"methodology":"case rate"}]}]},{"description":"PERTNL/COMPOSITE","code_information":[{"code":"831","type":"RC"}],"standard_charges":[{"minimum":519.05,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":691.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":519.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":519.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-HOMOVANILLIC ACID 80470A","code_information":[{"code":"83150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":63.07,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-HOMOVANILLIC ACID 80470A","code_information":[{"code":"83150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.44,"maximum":109.07,"gross_charge":119,"discounted_cash":27.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"}]}]},{"description":"RL-A-HOMOVANILLIC ACID U 80422","code_information":[{"code":"83150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-HOMOVANILLIC ACID U 80422","code_information":[{"code":"83150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.44,"maximum":109.07,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"minimum":5599.14,"maximum":14760.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13440,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13440,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7465.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5599.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5599.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13004.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10723.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14760.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7052.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7123.49,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7264.55,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7194.02,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7052.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7052.96,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7052.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7229.29,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7052.96,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"832","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"minimum":5292.92,"maximum":105086.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9995,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9995,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105086.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78816.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78816.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":9670.91,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7975.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10977.22,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5292.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5345.85,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5451.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5398.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5292.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5292.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5292.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5425.25,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5292.92,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"833","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA WITH MCC","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"minimum":44016.02,"maximum":120530.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109751,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109751,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74058.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55544.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55544.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":106187.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":87567.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":120530.77,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":44456.19,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":45336.51,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":44896.35,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":45116.43,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":44016.02,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"834","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-17-HYD CORT URINE 70490","code_information":[{"code":"83491","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-17-HYD CORT URINE 70490","code_information":[{"code":"83491","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":87.1,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-5-HYDROXYIN ACID UR 80420","code_information":[{"code":"83497","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.49,"maximum":26.97,"gross_charge":33,"discounted_cash":7.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-5-HYDROXYIN ACID UR 80420","code_information":[{"code":"83497","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.74,"maximum":62.77,"gross_charge":33,"discounted_cash":7.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-17HYDROXYPROG QN SP 92332","code_information":[{"code":"83498","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":147.87,"maximum":227.95,"gross_charge":279,"discounted_cash":63.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-17HYDROXYPROG QN SP 92332","code_information":[{"code":"83498","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.3,"maximum":227.95,"gross_charge":279,"discounted_cash":63.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":56.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":56.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":79.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27.17,"methodology":"fee schedule"}]}]},{"description":"ACUTE LEUKEMIA WITH CC","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"minimum":17790.26,"maximum":62959.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38099,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38099,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62959.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47220.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47220.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":36862.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30398.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41841.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17790.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17968.17,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18323.97,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18146.07,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17790.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17790.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17790.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18235.02,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17790.26,"methodology":"case rate"}]}]},{"description":"PERTNL/HOME/SUPSERV","code_information":[{"code":"835","type":"RC"}],"standard_charges":[{"minimum":486.45,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":486.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":486.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-CHROMATIN AB IGG 2005287","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":129.85,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROMATIN AB IGG 2005287","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-GANGLIOSIDE AB 51033","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-GANGLIOSIDE AB 51033","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":56.11,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-GBM IGG MULTIPLEX 51000","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-GBM IGG MULTIPLEX 51000","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":56.11,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-HMGCR AB IGG 2013101","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":252.28,"maximum":388.9,"gross_charge":476,"discounted_cash":109.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":252.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":388.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-HMGCR AB IGG 2013101","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":388.9,"gross_charge":476,"discounted_cash":109.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":252.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":388.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUN ANLYT MULTI 51225B","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUN ANLYT MULTI 51225B","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":56.11,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUN ANLYT MULTI2012729B","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":45.58,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUN ANLYT MULTI2012729B","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUN ANLYT MULTI3000480C","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":80.56,"maximum":124.19,"gross_charge":152,"discounted_cash":34.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUN ANLYT MULTI3000480C","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":124.19,"gross_charge":152,"discounted_cash":34.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYELOPEROXIDASE AB 50526","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYELOPEROXIDASE AB 50526","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"IMMUNO QL NONINFX SQ SINGL","code_information":[{"code":"83518","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":213.59,"maximum":329.26,"gross_charge":403,"discounted_cash":92.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":213.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":329.26,"methodology":"fee schedule"}]}]},{"description":"IMMUNO QL NONINFX SQ SINGL","code_information":[{"code":"83518","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.78,"maximum":329.26,"gross_charge":403,"discounted_cash":92.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":213.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":329.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"}]}]},{"description":"IMMUNOASSAY ANALYTE QN RIA","code_information":[{"code":"83519","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":95.93,"maximum":147.88,"gross_charge":181,"discounted_cash":41.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.88,"methodology":"fee schedule"}]}]},{"description":"IMMUNOASSAY ANALYTE QN RIA","code_information":[{"code":"83519","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.04,"maximum":147.88,"gross_charge":181,"discounted_cash":41.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-MUSK ANTIBODY IGG 3001576","code_information":[{"code":"83519","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":604.2,"maximum":931.38,"gross_charge":1140,"discounted_cash":261.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":604.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":931.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-MUSK ANTIBODY IGG 3001576","code_information":[{"code":"83519","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.04,"maximum":931.38,"gross_charge":1140,"discounted_cash":261.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":604.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":931.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-VGKC AB SERUM 2004890","code_information":[{"code":"83519","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":31.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"}]}]},{"description":"RL-A-VGKC AB SERUM 2004890","code_information":[{"code":"83519","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.04,"maximum":89.53,"gross_charge":59,"discounted_cash":13.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"}]}]},{"description":"IMMUNOASSAY ANALYTE QN NOS","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":163.24,"maximum":251.64,"gross_charge":308,"discounted_cash":70.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":251.64,"methodology":"fee schedule"}]}]},{"description":"IMMUNOASSAY ANALYTE QN NOS","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":251.64,"gross_charge":308,"discounted_cash":70.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":251.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOASY QN NOS 3002104C","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":28.09,"maximum":43.31,"gross_charge":53,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOASY QN NOS 3002104C","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":84.02,"gross_charge":53,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-INHIBIN B 70413","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":145.75,"maximum":224.68,"gross_charge":275,"discounted_cash":62.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":224.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-INHIBIN B 70413","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":224.68,"gross_charge":275,"discounted_cash":62.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":224.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEURON ANTIBOD CSF 98726","code_information":[{"code":"83520","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":149.46,"maximum":230.4,"gross_charge":282,"discounted_cash":64.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEURON ANTIBOD CSF 98726","code_information":[{"code":"83520","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":230.4,"gross_charge":282,"discounted_cash":64.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRYPTASE 99173","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":209.88,"maximum":323.54,"gross_charge":396,"discounted_cash":90.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":209.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":323.54,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRYPTASE 99173","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":323.54,"gross_charge":396,"discounted_cash":90.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":209.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":323.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-TSH RECEPTOR AB 2002734","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":318,"maximum":490.2,"gross_charge":600,"discounted_cash":137.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":318,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":490.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-TSH RECEPTOR AB 2002734","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":490.2,"gross_charge":600,"discounted_cash":137.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":318,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":490.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-VASC ENDOTHELIAL GF 92660","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-VASC ENDOTHELIAL GF 92660","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":84.02,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-KAP/LAM QN FREE LIG 55167","code_information":[{"code":"83521","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-KAP/LAM QN FREE LIG 55167","code_information":[{"code":"83521","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":84.02,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"}]}]},{"description":"INSULIN TOTAL","code_information":[{"code":"83525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"INSULIN TOTAL","code_information":[{"code":"83525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.85,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-INSULIN TOTAL 70155A","code_information":[{"code":"83525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":27.03,"maximum":41.67,"gross_charge":51,"discounted_cash":11.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-INSULIN TOTAL 70155A","code_information":[{"code":"83525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.85,"maximum":55.61,"gross_charge":51,"discounted_cash":11.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-INSULIN FREE 70155B","code_information":[{"code":"83527","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":28.09,"maximum":43.31,"gross_charge":53,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-INSULIN FREE 70155B","code_information":[{"code":"83527","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.77,"maximum":63.05,"gross_charge":53,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-INTERLEUKIN 6 SERUM 51537","code_information":[{"code":"83529","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":137.8,"maximum":212.42,"gross_charge":260,"discounted_cash":59.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-INTERLEUKIN 6 SERUM 51537","code_information":[{"code":"83529","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.36,"maximum":212.42,"gross_charge":260,"discounted_cash":59.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.36,"methodology":"fee schedule"}]}]},{"description":"IRON","code_information":[{"code":"83540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":81.09,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"}]}]},{"description":"IRON","code_information":[{"code":"83540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.88,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-IRON LIVER 28250","code_information":[{"code":"83540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-IRON LIVER 28250","code_information":[{"code":"83540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.88,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-17-KETOSTEROIDS UR 80650","code_information":[{"code":"83586","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":134.09,"maximum":206.71,"gross_charge":253,"discounted_cash":57.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-17-KETOSTEROIDS UR 80650","code_information":[{"code":"83586","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.68,"maximum":206.71,"gross_charge":253,"discounted_cash":57.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"}]}]},{"description":"ACUTE LEUKEMIA WITHOUT CC/MCC","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"minimum":11099.65,"maximum":90591.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24751,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24751,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90591.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":67945.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":67945.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23947.38,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19748.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27182.08,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11210.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11432.64,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11321.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.15,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"}]}]},{"description":"LACTATE LACTIC ACID","code_information":[{"code":"83605","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.66,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"}]}]},{"description":"LACTATE LACTIC ACID","code_information":[{"code":"83605","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.94,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"}]}]},{"description":"LACTATE DEHYDRO (LDH)","code_information":[{"code":"83615","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":94.34,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"}]}]},{"description":"LACTATE DEHYDRO (LDH)","code_information":[{"code":"83615","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.62,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-LACTATE DEHYDROGEN 20413B","code_information":[{"code":"83615","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":83.21,"maximum":128.27,"gross_charge":157,"discounted_cash":35.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-LACTATE DEHYDROGEN 20413B","code_information":[{"code":"83615","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.62,"maximum":128.27,"gross_charge":157,"discounted_cash":35.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-LDH ISOENZYMES 20413A","code_information":[{"code":"83625","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":41.87,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-LDH ISOENZYMES 20413A","code_information":[{"code":"83625","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.67,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"}]}]},{"description":"LACTOFERRIN FECAL QUAL","code_information":[{"code":"83630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":71.02,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"}]}]},{"description":"LACTOFERRIN FECAL QUAL","code_information":[{"code":"83630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.82,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-LACTOFERIN FECAL 61164","code_information":[{"code":"83630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":126.14,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-LACTOFERIN FECAL 61164","code_information":[{"code":"83630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.82,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-HUMAN PLACENTAL LAC 99721","code_information":[{"code":"83632","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":126.67,"maximum":195.27,"gross_charge":239,"discounted_cash":54.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":195.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-HUMAN PLACENTAL LAC 99721","code_information":[{"code":"83632","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.13,"maximum":195.27,"gross_charge":239,"discounted_cash":54.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":195.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEAD 20584C","code_information":[{"code":"83655","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":348.21,"maximum":536.77,"gross_charge":657,"discounted_cash":150.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":348.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":536.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEAD 20584C","code_information":[{"code":"83655","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.26,"maximum":536.77,"gross_charge":657,"discounted_cash":150.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":348.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":536.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEAD 99470B","code_information":[{"code":"83655","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":39.75,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEAD 99470B","code_information":[{"code":"83655","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.26,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEAD URINE 25060","code_information":[{"code":"83655","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":104.94,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEAD URINE 25060","code_information":[{"code":"83655","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.26,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"FETAL LUNG MATURITY L/S RATIO","code_information":[{"code":"83661","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":124.55,"maximum":192,"gross_charge":235,"discounted_cash":53.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192,"methodology":"fee schedule"}]}]},{"description":"FETAL LUNG MATURITY L/S RATIO","code_information":[{"code":"83661","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":192,"gross_charge":235,"discounted_cash":53.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":64.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"}]}]},{"description":"FLM LAMELLAR BODY DENSITY","code_information":[{"code":"83664","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":77.38,"maximum":119.29,"gross_charge":146,"discounted_cash":33.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.29,"methodology":"fee schedule"}]}]},{"description":"FLM LAMELLAR BODY DENSITY","code_information":[{"code":"83664","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.59,"maximum":119.29,"gross_charge":146,"discounted_cash":33.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"}]}]},{"description":"LIPASE","code_information":[{"code":"83690","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":60.42,"maximum":93.14,"gross_charge":114,"discounted_cash":26.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"}]}]},{"description":"LIPASE","code_information":[{"code":"83690","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.13,"maximum":93.14,"gross_charge":114,"discounted_cash":26.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"LIPASE BODY FLUID","code_information":[{"code":"83690","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.12,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"}]}]},{"description":"LIPASE BODY FLUID","code_information":[{"code":"83690","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.13,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-LIPOPROTEIN A 99174","code_information":[{"code":"83695","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":30.21,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-LIPOPROTEIN A 99174","code_information":[{"code":"83695","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.59,"maximum":69.71,"gross_charge":57,"discounted_cash":13.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"minimum":39994.07,"maximum":123590.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112537,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112537,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56646.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42485.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42485.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":108882.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":89790.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":123590.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":39994.07,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":40394.02,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41193.9,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":40793.96,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":39994.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39994.07,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":39994.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40993.93,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":39994.07,"methodology":"case rate"}]}]},{"description":"RL-A-LIPOPROTEIN ELECTR 80503A","code_information":[{"code":"83700","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-LIPOPROTEIN ELECTR 80503A","code_information":[{"code":"83700","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.75,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"}]}]},{"description":"LIPOPROTEIN BLD QN INCL SUBCL","code_information":[{"code":"83704","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":78.44,"maximum":120.92,"gross_charge":148,"discounted_cash":33.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"}]}]},{"description":"LIPOPROTEIN BLD QN INCL SUBCL","code_information":[{"code":"83704","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":20.51,"maximum":166.4,"gross_charge":148,"discounted_cash":33.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34.19,"methodology":"fee schedule"}]}]},{"description":"CHOLESTEROL HDL MEASURED","code_information":[{"code":"83718","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":111.83,"maximum":172.39,"gross_charge":211,"discounted_cash":48.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"}]}]},{"description":"CHOLESTEROL HDL MEASURED","code_information":[{"code":"83718","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.91,"maximum":172.39,"gross_charge":211,"discounted_cash":48.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"}]}]},{"description":"CHOLESTEROL LDL MEASURED","code_information":[{"code":"83721","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":75.79,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"}]}]},{"description":"CHOLESTEROL LDL MEASURED","code_information":[{"code":"83721","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.3,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM","code_information":[{"code":"83735","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":118.72,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM","code_information":[{"code":"83735","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.02,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-MANGANESE SERUM 99265","code_information":[{"code":"83785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":80.03,"maximum":123.37,"gross_charge":151,"discounted_cash":34.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.37,"methodology":"fee schedule"}]}]},{"description":"RL-A-MANGANESE SERUM 99265","code_information":[{"code":"83785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.99,"maximum":129.68,"gross_charge":151,"discounted_cash":34.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":77.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-MANGANESE WHOLE BLD 99272","code_information":[{"code":"83785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.36,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-MANGANESE WHOLE BLD 99272","code_information":[{"code":"83785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.99,"maximum":129.68,"gross_charge":112,"discounted_cash":25.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":77.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"methodology":"fee schedule"}]}]},{"description":"MASS SPECT NOS QL/QN EACH SPEC","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":361.46,"maximum":557.2,"gross_charge":682,"discounted_cash":156.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":361.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":557.2,"methodology":"fee schedule"}]}]},{"description":"MASS SPECT NOS QL/QN EACH SPEC","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.46,"maximum":557.2,"gross_charge":682,"discounted_cash":156.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":361.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":557.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL AFB ID MALDI 2009960","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":120.84,"maximum":186.28,"gross_charge":228,"discounted_cash":52.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":186.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL AFB ID MALDI 2009960","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.46,"maximum":186.28,"gross_charge":228,"discounted_cash":52.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":186.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL MALDI FUNG 2007693","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":17.98,"gross_charge":22,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL MALDI FUNG 2007693","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":117.3,"gross_charge":22,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL MALDI-TOF 2005162","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.84,"maximum":22.88,"gross_charge":28,"discounted_cash":6.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL MALDI-TOF 2005162","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.46,"maximum":117.3,"gross_charge":28,"discounted_cash":6.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"minimum":16957.41,"maximum":45136.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41099,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41099,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38216.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28662.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28662.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39765.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32792.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45136.37,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16957.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17126.99,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17466.14,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17296.56,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16957.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16957.41,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16957.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17381.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16957.41,"methodology":"case rate"}]}]},{"description":"RL-A-MERCURY 20584D","code_information":[{"code":"83825","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":157.94,"maximum":243.47,"gross_charge":298,"discounted_cash":68.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":243.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-MERCURY 20584D","code_information":[{"code":"83825","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.75,"maximum":243.47,"gross_charge":298,"discounted_cash":68.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":243.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-MERCURY 99470C","code_information":[{"code":"83825","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.41,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-MERCURY 99470C","code_information":[{"code":"83825","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.75,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-MERCURY URINE 25050","code_information":[{"code":"83825","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":162.18,"maximum":250.01,"gross_charge":306,"discounted_cash":70.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":162.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-MERCURY URINE 25050","code_information":[{"code":"83825","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.75,"maximum":250.01,"gross_charge":306,"discounted_cash":70.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":162.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-METANEPHINES FREE 50184","code_information":[{"code":"83835","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":154.23,"maximum":237.75,"gross_charge":291,"discounted_cash":66.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-METANEPHINES FREE 50184","code_information":[{"code":"83835","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.16,"maximum":237.75,"gross_charge":291,"discounted_cash":66.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-METANEPHR FRAC UR 2007996","code_information":[{"code":"83835","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":422.94,"maximum":651.97,"gross_charge":798,"discounted_cash":182.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":422.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":651.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-METANEPHR FRAC UR 2007996","code_information":[{"code":"83835","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.16,"maximum":651.97,"gross_charge":798,"discounted_cash":182.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":422.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":651.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"}]}]},{"description":"MUCOPOLYSACCHARIDES QN","code_information":[{"code":"83864","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"MUCOPOLYSACCHARIDES QN","code_information":[{"code":"83864","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.1,"maximum":138.7,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":83.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYELIN BASIC PROTEIN80515","code_information":[{"code":"83873","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":56.18,"maximum":86.61,"gross_charge":106,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYELIN BASIC PROTEIN80515","code_information":[{"code":"83873","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.32,"maximum":86.61,"gross_charge":106,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"}]}]},{"description":"MYOGLOBIN BLOOD","code_information":[{"code":"83874","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":208.82,"maximum":321.9,"gross_charge":394,"discounted_cash":90.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":208.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":321.9,"methodology":"fee schedule"}]}]},{"description":"MYOGLOBIN BLOOD","code_information":[{"code":"83874","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.75,"maximum":321.9,"gross_charge":394,"discounted_cash":90.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":208.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":321.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"}]}]},{"description":"MYOGLOBIN URINE","code_information":[{"code":"83874","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":190.27,"maximum":293.31,"gross_charge":359,"discounted_cash":82.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":293.31,"methodology":"fee schedule"}]}]},{"description":"MYOGLOBIN URINE","code_information":[{"code":"83874","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.75,"maximum":293.31,"gross_charge":359,"discounted_cash":82.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":293.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYOGLOBIN URINE 20223","code_information":[{"code":"83874","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":197.16,"maximum":303.93,"gross_charge":372,"discounted_cash":85.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":197.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":303.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYOGLOBIN URINE 20223","code_information":[{"code":"83874","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.75,"maximum":303.93,"gross_charge":372,"discounted_cash":85.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":197.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":303.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"}]}]},{"description":"NATRIURETIC PEPTIDE","code_information":[{"code":"83880","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":289.91,"maximum":446.9,"gross_charge":547,"discounted_cash":125.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":289.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.9,"methodology":"fee schedule"}]}]},{"description":"NATRIURETIC PEPTIDE","code_information":[{"code":"83880","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.55,"maximum":446.9,"gross_charge":547,"discounted_cash":125.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":114.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":289.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":40.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROBRAIN NATRIU PEP 50083","code_information":[{"code":"83880","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":107.59,"maximum":165.86,"gross_charge":203,"discounted_cash":46.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROBRAIN NATRIU PEP 50083","code_information":[{"code":"83880","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.55,"maximum":191.09,"gross_charge":203,"discounted_cash":46.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":114.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":40.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEPHELOMETRY EA 2005661E","code_information":[{"code":"83883","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEPHELOMETRY EA 2005661E","code_information":[{"code":"83883","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.16,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"minimum":11870.63,"maximum":52084.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23973,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23973,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52084.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39064.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39064.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23194.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19127.68,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26328,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11870.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11989.34,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12226.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12108.05,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11870.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11870.63,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11870.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12167.4,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11870.63,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"839","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-5 NUCLEOTIDASE 80235","code_information":[{"code":"83915","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.55,"maximum":28.6,"gross_charge":35,"discounted_cash":8.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-5 NUCLEOTIDASE 80235","code_information":[{"code":"83915","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.69,"maximum":54.25,"gross_charge":35,"discounted_cash":8.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-OLIGOCLONAL BANDS 80440B","code_information":[{"code":"83916","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":65.72,"maximum":101.31,"gross_charge":124,"discounted_cash":28.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-OLIGOCLONAL BANDS 80440B","code_information":[{"code":"83916","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.43,"maximum":133.33,"gross_charge":124,"discounted_cash":28.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":80.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-ORGANIC ACIDS URINE 98389","code_information":[{"code":"83918","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":171.72,"maximum":264.71,"gross_charge":324,"discounted_cash":74.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-ORGANIC ACIDS URINE 98389","code_information":[{"code":"83918","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.16,"maximum":264.71,"gross_charge":324,"discounted_cash":74.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":69.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHYLMALON ACID SP 99431","code_information":[{"code":"83921","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHYLMALON ACID SP 99431","code_information":[{"code":"83921","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":103.2,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":62.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHYLMALONIC QN UR 83918","code_information":[{"code":"83921","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.35,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHYLMALONIC QN UR 83918","code_information":[{"code":"83921","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":103.2,"gross_charge":95,"discounted_cash":21.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":62.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"}]}]},{"description":"OSMOLALITY BLOOD","code_information":[{"code":"83930","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":109.71,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"}]}]},{"description":"OSMOLALITY BLOOD","code_information":[{"code":"83930","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.96,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"}]}]},{"description":"OSMOLALITY URINE","code_information":[{"code":"83935","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":95.93,"maximum":147.88,"gross_charge":181,"discounted_cash":41.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.88,"methodology":"fee schedule"}]}]},{"description":"OSMOLALITY URINE","code_information":[{"code":"83935","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.09,"maximum":147.88,"gross_charge":181,"discounted_cash":41.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-OSTEOCALCIN NMID 20728","code_information":[{"code":"83937","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":91.16,"maximum":140.53,"gross_charge":172,"discounted_cash":39.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-OSTEOCALCIN NMID 20728","code_information":[{"code":"83937","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.91,"maximum":145.29,"gross_charge":172,"discounted_cash":39.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":87.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":30.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-OXALATE URINE 20482","code_information":[{"code":"83945","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":41.87,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-OXALATE URINE 20482","code_information":[{"code":"83945","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.67,"maximum":70.35,"gross_charge":79,"discounted_cash":18.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-ONCOPROTEIN DCP 81326B","code_information":[{"code":"83951","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":134.09,"maximum":206.71,"gross_charge":253,"discounted_cash":57.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-ONCOPROTEIN DCP 81326B","code_information":[{"code":"83951","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.64,"maximum":313.48,"gross_charge":253,"discounted_cash":57.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":133.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":133.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":188.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":65.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":66.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":65.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":66.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"}]}]},{"description":"PARATHORMONE (PTH) INTACT","code_information":[{"code":"83970","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":89.04,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"}]}]},{"description":"PARATHORMONE (PTH) INTACT","code_information":[{"code":"83970","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.76,"maximum":200.9,"gross_charge":168,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":120.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":41.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"}]}]},{"description":"PARATHORMONE (PTH) INTRAOP","code_information":[{"code":"83970","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":329.13,"maximum":507.36,"gross_charge":621,"discounted_cash":142.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":329.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":507.36,"methodology":"fee schedule"}]}]},{"description":"PARATHORMONE (PTH) INTRAOP","code_information":[{"code":"83970","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.76,"maximum":507.36,"gross_charge":621,"discounted_cash":142.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":120.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":329.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":507.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":41.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-PARATHORMONE 70172B","code_information":[{"code":"83970","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.45,"maximum":134.81,"gross_charge":165,"discounted_cash":37.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":134.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-PARATHORMONE 70172B","code_information":[{"code":"83970","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.76,"maximum":200.9,"gross_charge":165,"discounted_cash":37.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":120.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":134.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":41.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"}]}]},{"description":"PH BODY FLUID NOT BLOOD","code_information":[{"code":"83986","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":115.54,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"PH BODY FLUID NOT BLOOD","code_information":[{"code":"83986","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-PH FECAL 20518","code_information":[{"code":"83986","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.6,"maximum":16.34,"gross_charge":20,"discounted_cash":4.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-PH FECAL 20518","code_information":[{"code":"83986","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":17.39,"gross_charge":20,"discounted_cash":4.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-CALPROTECTN FECAL 3002859","code_information":[{"code":"83993","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-CALPROTECTN FECAL 3002859","code_information":[{"code":"83993","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.77,"maximum":95.55,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.63,"methodology":"fee schedule"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"minimum":25933.9,"maximum":65916.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60021,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60021,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39922.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29942.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29942.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":58072.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47889.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65916.97,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25933.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26193.24,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26711.92,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26452.58,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25933.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25933.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25933.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26582.25,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25933.9,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"840","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-ACID PHOSPHATASE S 20544","code_information":[{"code":"84060","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACID PHOSPHATASE S 20544","code_information":[{"code":"84060","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.58,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROSTATIC ACID PHOS 70120","code_information":[{"code":"84066","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROSTATIC ACID PHOS 70120","code_information":[{"code":"84066","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.79,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"}]}]},{"description":"PHOSPHATASE ALKALINE","code_information":[{"code":"84075","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":27.56,"maximum":42.49,"gross_charge":52,"discounted_cash":11.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"PHOSPHATASE ALKALINE","code_information":[{"code":"84075","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":42.49,"gross_charge":52,"discounted_cash":11.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHOSPHATASE ALKAL 21020A","code_information":[{"code":"84075","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.96,"maximum":26.15,"gross_charge":32,"discounted_cash":7.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHOSPHATASE ALKAL 21020A","code_information":[{"code":"84075","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":26.15,"gross_charge":32,"discounted_cash":7.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-BONE SPEC ALK PHOS 70053","code_information":[{"code":"84080","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":62.01,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-BONE SPEC ALK PHOS 70053","code_information":[{"code":"84080","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.86,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHOSPH ALKALIN ISO 21020B","code_information":[{"code":"84080","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHOSPH ALKALIN ISO 21020B","code_information":[{"code":"84080","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.86,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"}]}]},{"description":"PHOSPHATIDYLGLYCEROL","code_information":[{"code":"84081","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"}]}]},{"description":"PHOSPHATIDYLGLYCEROL","code_information":[{"code":"84081","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.91,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"}]}]},{"description":"CAPD/COMPOSITE","code_information":[{"code":"841","type":"RC"}],"standard_charges":[{"minimum":474.56,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":632.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":474.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":474.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"minimum":13398.67,"maximum":33249.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30275,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30275,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29588.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22191.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22191.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29292.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24156.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33249.37,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13398.67,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13532.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13800.64,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13666.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13398.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13398.67,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13398.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13733.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13398.67,"methodology":"case rate"}]}]},{"description":"PHOSPHORUS INORGANIC","code_information":[{"code":"84100","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":39.22,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"}]}]},{"description":"PHOSPHORUS INORGANIC","code_information":[{"code":"84100","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.84,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"}]}]},{"description":"PHOSPHORUS URINE","code_information":[{"code":"84105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":67.31,"maximum":103.76,"gross_charge":127,"discounted_cash":29.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"}]}]},{"description":"PHOSPHORUS URINE","code_information":[{"code":"84105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.46,"maximum":103.76,"gross_charge":127,"discounted_cash":29.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT","code_information":[{"code":"8411","type":"APR-DRG"}],"standard_charges":[{"minimum":35382,"maximum":35382,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35382,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35382,"methodology":"case rate"}]}]},{"description":"RL-A-PORPHOBILIN UR QN2002181B","code_information":[{"code":"84110","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHOBILIN UR QN2002181B","code_information":[{"code":"84110","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.06,"maximum":41.08,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHOBILINOGEN UR 80260","code_information":[{"code":"84110","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":28.09,"maximum":43.31,"gross_charge":53,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHOBILINOGEN UR 80260","code_information":[{"code":"84110","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.06,"maximum":43.31,"gross_charge":53,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"}]}]},{"description":"AMNIOTIC PROT QL PAMG1/PP12","code_information":[{"code":"84112","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":256.52,"maximum":395.43,"gross_charge":484,"discounted_cash":110.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":256.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":395.43,"methodology":"fee schedule"}]}]},{"description":"AMNIOTIC PROT QL PAMG1/PP12","code_information":[{"code":"84112","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.86,"maximum":477.44,"gross_charge":484,"discounted_cash":110.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":203.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":203.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":286.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":256.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":395.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":58.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":58.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":99.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":101.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":100.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":100.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":98.11,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT","code_information":[{"code":"8412","type":"APR-DRG"}],"standard_charges":[{"minimum":35382,"maximum":35382,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35382,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35382,"methodology":"case rate"}]}]},{"description":"RL-A-PORPHYRIN FR QN UR2002058","code_information":[{"code":"84120","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYRIN FR QN UR2002058","code_information":[{"code":"84120","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.82,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYRINS U QN 2002181A","code_information":[{"code":"84120","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYRINS U QN 2002181A","code_information":[{"code":"84120","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.82,"maximum":71.57,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYRINS FECAL 99824","code_information":[{"code":"84126","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":124.02,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYRINS FECAL 99824","code_information":[{"code":"84126","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.46,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":114.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":39.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT","code_information":[{"code":"8413","type":"APR-DRG"}],"standard_charges":[{"minimum":54446,"maximum":54446,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54446,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54446,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54446,"methodology":"case rate"}]}]},{"description":"POTASSIUM SERUM","code_information":[{"code":"84132","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":63.07,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM SERUM","code_information":[{"code":"84132","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM URINE","code_information":[{"code":"84133","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":90.1,"maximum":138.89,"gross_charge":170,"discounted_cash":38.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.89,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM URINE","code_information":[{"code":"84133","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.83,"maximum":138.89,"gross_charge":170,"discounted_cash":38.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"}]}]},{"description":"PREALBUMIN","code_information":[{"code":"84134","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":63.07,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"PREALBUMIN","code_information":[{"code":"84134","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.75,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.59,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT","code_information":[{"code":"8414","type":"APR-DRG"}],"standard_charges":[{"minimum":137062,"maximum":137062,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":137062,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":137062,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":137062,"methodology":"case rate"}]}]},{"description":"RL-A-PREGNENOLONE SP 92334","code_information":[{"code":"84140","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.41,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-PREGNENOLONE SP 92334","code_information":[{"code":"84140","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.4,"maximum":100.63,"gross_charge":97,"discounted_cash":22.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"}]}]},{"description":"PROGESTERONE","code_information":[{"code":"84144","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":191.33,"maximum":294.94,"gross_charge":361,"discounted_cash":82.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.94,"methodology":"fee schedule"}]}]},{"description":"PROGESTERONE","code_information":[{"code":"84144","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.51,"maximum":294.94,"gross_charge":361,"discounted_cash":82.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.86,"methodology":"fee schedule"}]}]},{"description":"PROCALCITONIN (PCT)","code_information":[{"code":"84145","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":139.39,"maximum":214.88,"gross_charge":263,"discounted_cash":60.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.88,"methodology":"fee schedule"}]}]},{"description":"PROCALCITONIN (PCT)","code_information":[{"code":"84145","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.33,"maximum":214.88,"gross_charge":263,"discounted_cash":60.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":56.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":56.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":79.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":27.22,"methodology":"fee schedule"}]}]},{"description":"PROLACTIN","code_information":[{"code":"84146","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":160.06,"maximum":246.74,"gross_charge":302,"discounted_cash":69.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":160.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":246.74,"methodology":"fee schedule"}]}]},{"description":"PROLACTIN","code_information":[{"code":"84146","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.62,"maximum":246.74,"gross_charge":302,"discounted_cash":69.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":160.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":246.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-MACROPROLACTIN 20765","code_information":[{"code":"84146","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":147.87,"maximum":227.95,"gross_charge":279,"discounted_cash":63.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-MACROPROLACTIN 20765","code_information":[{"code":"84146","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.62,"maximum":227.95,"gross_charge":279,"discounted_cash":63.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"}]}]},{"description":"PROSATE SPECIFIC AG TOTAL","code_information":[{"code":"84153","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":145.75,"maximum":224.68,"gross_charge":275,"discounted_cash":62.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":224.68,"methodology":"fee schedule"}]}]},{"description":"PROSATE SPECIFIC AG TOTAL","code_information":[{"code":"84153","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.03,"maximum":224.68,"gross_charge":275,"discounted_cash":62.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":224.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-PSA TOTAL 80206A","code_information":[{"code":"84153","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-PSA TOTAL 80206A","code_information":[{"code":"84153","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.03,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-PSA FREE 80206B","code_information":[{"code":"84154","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":141.51,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-PSA FREE 80206B","code_information":[{"code":"84154","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.03,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"}]}]},{"description":"PROTEIN TL SERUM/BLD/PLASMA","code_information":[{"code":"84155","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":89.04,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"}]}]},{"description":"PROTEIN TL SERUM/BLD/PLASMA","code_information":[{"code":"84155","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.2,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN TOTAL 51225A","code_information":[{"code":"84155","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN TOTAL 51225A","code_information":[{"code":"84155","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.2,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"}]}]},{"description":"PROTEIN TOTAL URINE 24HR","code_information":[{"code":"84156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.45,"maximum":53.11,"gross_charge":65,"discounted_cash":14.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"}]}]},{"description":"PROTEIN TOTAL URINE 24HR","code_information":[{"code":"84156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.2,"maximum":53.11,"gross_charge":65,"discounted_cash":14.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN TOTAL URN3002104A","code_information":[{"code":"84156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":28.09,"maximum":43.31,"gross_charge":53,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN TOTAL URN3002104A","code_information":[{"code":"84156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.2,"maximum":43.31,"gross_charge":53,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"}]}]},{"description":"PROTEIN CSF","code_information":[{"code":"84157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.1,"maximum":57.19,"gross_charge":70,"discounted_cash":16.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"}]}]},{"description":"PROTEIN CSF","code_information":[{"code":"84157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.4,"maximum":57.19,"gross_charge":70,"discounted_cash":16.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"}]}]},{"description":"RL-A-TOTAL PROTEIN OTHER50590A","code_information":[{"code":"84157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.78,"maximum":21.25,"gross_charge":26,"discounted_cash":5.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-TOTAL PROTEIN OTHER50590A","code_information":[{"code":"84157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.4,"maximum":21.25,"gross_charge":26,"discounted_cash":5.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"}]}]},{"description":"PROTEIN ELECTROPHORETIC SERUM","code_information":[{"code":"84165","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":202.99,"maximum":312.92,"gross_charge":383,"discounted_cash":87.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":202.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.92,"methodology":"fee schedule"}]}]},{"description":"PROTEIN ELECTROPHORETIC SERUM","code_information":[{"code":"84165","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.44,"maximum":312.92,"gross_charge":383,"discounted_cash":87.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":202.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROT EP FRC QN S 51225E","code_information":[{"code":"84165","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROT EP FRC QN S 51225E","code_information":[{"code":"84165","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.44,"maximum":52.25,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"PROTEIN ELECTROPHORESIS OTHER","code_information":[{"code":"84166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":183.91,"maximum":283.5,"gross_charge":347,"discounted_cash":79.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":183.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"}]}]},{"description":"PROTEIN ELECTROPHORESIS OTHER","code_information":[{"code":"84166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.69,"maximum":283.5,"gross_charge":347,"discounted_cash":79.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":183.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROT EP FRC QN OTH 50590B","code_information":[{"code":"84166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROT EP FRC QN OTH 50590B","code_information":[{"code":"84166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.69,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-14-3-3 PR TAU CSF3001255B","code_information":[{"code":"84182","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":453.6,"maximum":699.23,"gross_charge":855.84,"discounted_cash":195.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":699.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-14-3-3 PR TAU CSF3001255B","code_information":[{"code":"84182","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.52,"maximum":699.23,"gross_charge":855.84,"discounted_cash":195.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":699.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEURONAL IB SRM 3002917","code_information":[{"code":"84182","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":72.08,"maximum":111.12,"gross_charge":136,"discounted_cash":31.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEURONAL IB SRM 3002917","code_information":[{"code":"84182","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.52,"maximum":142.14,"gross_charge":136,"discounted_cash":31.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"minimum":9407.66,"maximum":32886.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21538,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21538,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32886.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24665.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24665.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20839.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17185.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23654.35,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9407.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9501.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9689.89,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9595.82,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9407.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9407.66,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9407.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9642.86,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9407.66,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"842","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-ERYTHROCYTE PORP WB 20610","code_information":[{"code":"84202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":47.17,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-ERYTHROCYTE PORP WB 20610","code_information":[{"code":"84202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.61,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZINC PROTOPORPH WB 20605","code_information":[{"code":"84202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.93,"maximum":66.18,"gross_charge":81,"discounted_cash":18.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZINC PROTOPORPH WB 20605","code_information":[{"code":"84202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.61,"maximum":69.85,"gross_charge":81,"discounted_cash":18.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROINSULIN INTACT 70112","code_information":[{"code":"84206","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROINSULIN INTACT 70112","code_information":[{"code":"84206","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.01,"maximum":129.9,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":78.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN B6 80111","code_information":[{"code":"84207","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":376.83,"maximum":580.89,"gross_charge":711,"discounted_cash":162.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":376.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":580.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN B6 80111","code_information":[{"code":"84207","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.86,"maximum":580.89,"gross_charge":711,"discounted_cash":162.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":82.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":376.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":580.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":28.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28.1,"methodology":"fee schedule"}]}]},{"description":"BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS","code_information":[{"code":"8421","type":"APR-DRG"}],"standard_charges":[{"minimum":9593,"maximum":9593,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9593,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9593,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9593,"methodology":"case rate"}]}]},{"description":"RL-A-PYRUVIC ACID 80310","code_information":[{"code":"84210","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-PYRUVIC ACID 80310","code_information":[{"code":"84210","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.68,"maximum":70.5,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"}]}]},{"description":"BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS","code_information":[{"code":"8422","type":"APR-DRG"}],"standard_charges":[{"minimum":15045,"maximum":15045,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15045,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15045,"methodology":"case rate"}]}]},{"description":"RL-A-PYRUVATE KINASE 80290","code_information":[{"code":"84220","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.15,"maximum":44.94,"gross_charge":55,"discounted_cash":12.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-PYRUVATE KINASE 80290","code_information":[{"code":"84220","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.66,"maximum":45.95,"gross_charge":55,"discounted_cash":12.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"}]}]},{"description":"BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS","code_information":[{"code":"8423","type":"APR-DRG"}],"standard_charges":[{"minimum":27752,"maximum":27752,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27752,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27752,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27752,"methodology":"case rate"}]}]},{"description":"RL-A-SOL TRANSFERRIN REC 70283","code_information":[{"code":"84238","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.08,"maximum":29.42,"gross_charge":36,"discounted_cash":8.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-SOL TRANSFERRIN REC 70283","code_information":[{"code":"84238","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.08,"maximum":177.99,"gross_charge":36,"discounted_cash":8.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":75.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":75.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":106.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"}]}]},{"description":"BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS","code_information":[{"code":"8424","type":"APR-DRG"}],"standard_charges":[{"minimum":68160,"maximum":68160,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68160,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68160,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68160,"methodology":"case rate"}]}]},{"description":"RL-A-RENIN ACTIVITY 70105","code_information":[{"code":"84244","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":174.9,"maximum":269.61,"gross_charge":330,"discounted_cash":75.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-RENIN ACTIVITY 70105","code_information":[{"code":"84244","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":269.61,"gross_charge":330,"discounted_cash":75.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":64.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN B2 RIBOFLAV 81123","code_information":[{"code":"84252","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":197.16,"maximum":303.93,"gross_charge":372,"discounted_cash":85.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":197.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":303.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN B2 RIBOFLAV 81123","code_information":[{"code":"84252","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.14,"maximum":303.93,"gross_charge":372,"discounted_cash":85.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":59.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":197.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":303.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"}]}]},{"description":"RL-A-SELENIUM SRM/PLASMA 25023","code_information":[{"code":"84255","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.61,"maximum":30.23,"gross_charge":37,"discounted_cash":8.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-SELENIUM SRM/PLASMA 25023","code_information":[{"code":"84255","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.31,"maximum":124.25,"gross_charge":37,"discounted_cash":8.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":124.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-SEROTONIN WHOLE BLD 80395","code_information":[{"code":"84260","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":101.76,"maximum":156.87,"gross_charge":192,"discounted_cash":43.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-SEROTONIN WHOLE BLD 80395","code_information":[{"code":"84260","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.58,"maximum":156.87,"gross_charge":192,"discounted_cash":43.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":64.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":64.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-SEX HORM BIND GLOB 70102A","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":75.26,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-SEX HORM BIND GLOB 70102A","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.03,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-SEX HORM BIND GLOB 81056A","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":46.11,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-SEX HORM BIND GLOB 81056A","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.03,"maximum":105.78,"gross_charge":87,"discounted_cash":19.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-SEX HORM BIND GLOB 81057B","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":17.16,"gross_charge":21,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-SEX HORM BIND GLOB 81057B","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":105.78,"gross_charge":21,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"}]}]},{"description":"SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":32.86,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"}]}]},{"description":"SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.03,"maximum":105.78,"gross_charge":62,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":63.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"}]}]},{"description":"SODIUM SERUM/BLD/PLASMA","code_information":[{"code":"84295","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"SODIUM SERUM/BLD/PLASMA","code_information":[{"code":"84295","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.88,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"minimum":15914.22,"maximum":39357.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35838,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35838,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24960.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18720.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18720.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":34674.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28594.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39357.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15914.22,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16073.37,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16391.65,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16232.51,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15914.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15914.22,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15914.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16312.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15914.22,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"843","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"SODIUM URINE","code_information":[{"code":"84300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":46.64,"maximum":71.9,"gross_charge":88,"discounted_cash":20.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.9,"methodology":"fee schedule"}]}]},{"description":"SODIUM URINE","code_information":[{"code":"84300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.03,"maximum":71.9,"gross_charge":88,"discounted_cash":20.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-SODIUM OTHER 60185B","code_information":[{"code":"84302","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.65,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-SODIUM OTHER 60185B","code_information":[{"code":"84302","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.91,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"}]}]},{"description":"SODIUM OTHER SOURCE","code_information":[{"code":"84302","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.32,"maximum":35.95,"gross_charge":44,"discounted_cash":10.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"}]}]},{"description":"SODIUM OTHER SOURCE","code_information":[{"code":"84302","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.91,"maximum":35.95,"gross_charge":44,"discounted_cash":10.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-IGF 1 Z SCORE 2007698","code_information":[{"code":"84305","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":71.02,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-IGF 1 Z SCORE 2007698","code_information":[{"code":"84305","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.75,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":62.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.8,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8431","type":"APR-DRG"}],"standard_charges":[{"minimum":3865,"maximum":3865,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3865,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3865,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3865,"methodology":"case rate"}]}]},{"description":"O2 SATURATION SPECT","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":98.58,"maximum":151.97,"gross_charge":186,"discounted_cash":42.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.97,"methodology":"fee schedule"}]}]},{"description":"O2 SATURATION SPECT","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":151.97,"gross_charge":186,"discounted_cash":42.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADACSF 3002982","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADACSF 3002982","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":39.44,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-ARYLSULFAT A 24H UR 95227","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":22.79,"maximum":35.14,"gross_charge":43,"discounted_cash":9.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-ARYLSULFAT A 24H UR 95227","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":39.44,"gross_charge":43,"discounted_cash":9.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHOSPHOLIPID SP 20042","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":31.87,"gross_charge":39,"discounted_cash":8.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHOSPHOLIPID SP 20042","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":39.44,"gross_charge":39,"discounted_cash":8.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYR TOT W/RFL 2006593","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":93.81,"maximum":144.61,"gross_charge":177,"discounted_cash":40.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYR TOT W/RFL 2006593","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":144.61,"gross_charge":177,"discounted_cash":40.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYRINS TOTAL 80429","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.96,"maximum":26.15,"gross_charge":32,"discounted_cash":7.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-PORPHYRINS TOTAL 80429","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":39.44,"gross_charge":32,"discounted_cash":7.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"SPECIFIC GRAVITY NON URINE","code_information":[{"code":"84315","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"SPECIFIC GRAVITY NON URINE","code_information":[{"code":"84315","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":1.96,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8432","type":"APR-DRG"}],"standard_charges":[{"minimum":6562,"maximum":6562,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6562,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6562,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6562,"methodology":"case rate"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8433","type":"APR-DRG"}],"standard_charges":[{"minimum":9221,"maximum":9221,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9221,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9221,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9221,"methodology":"case rate"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8434","type":"APR-DRG"}],"standard_charges":[{"minimum":33924,"maximum":33924,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33924,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33924,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33924,"methodology":"case rate"}]}]},{"description":"RL-A-REDUC SUBST FECAL 3002514","code_information":[{"code":"84376","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.43,"maximum":25.33,"gross_charge":31,"discounted_cash":7.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-REDUC SUBST FECAL 3002514","code_information":[{"code":"84376","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.3,"maximum":26.77,"gross_charge":31,"discounted_cash":7.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"}]}]},{"description":"SUGARS MULTIPLE QUALITATIVE","code_information":[{"code":"84377","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"SUGARS MULTIPLE QUALITATIVE","code_information":[{"code":"84377","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.3,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-1 5 ANHYDROG QN SP 81335","code_information":[{"code":"84378","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.51,"maximum":54.74,"gross_charge":67,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-1 5 ANHYDROG QN SP 81335","code_information":[{"code":"84378","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":56.11,"gross_charge":67,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"minimum":10515.8,"maximum":24921.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22692,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22692,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19447.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14585.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14585.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21955.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18105.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24921.04,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10515.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10620.96,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10831.28,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10726.12,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10515.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10515.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10515.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10778.7,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10515.8,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"844","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-TESTOSTER FREE MALE 70111","code_information":[{"code":"84402","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTER FREE MALE 70111","code_information":[{"code":"84402","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.28,"maximum":123.96,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE FREE 81056C","code_information":[{"code":"84402","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE FREE 81056C","code_information":[{"code":"84402","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.28,"maximum":123.96,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE FREE 81057C","code_information":[{"code":"84402","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":17.16,"gross_charge":21,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE FREE 81057C","code_information":[{"code":"84402","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":123.96,"gross_charge":21,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"}]}]},{"description":"TESTOSTERONE FREE","code_information":[{"code":"84402","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":142.57,"maximum":219.78,"gross_charge":269,"discounted_cash":61.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":142.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"}]}]},{"description":"TESTOSTERONE FREE","code_information":[{"code":"84402","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.28,"maximum":219.78,"gross_charge":269,"discounted_cash":61.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":142.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOS ADULT MALE 70130","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":77.38,"maximum":119.29,"gross_charge":146,"discounted_cash":33.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOS ADULT MALE 70130","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.48,"maximum":125.61,"gross_charge":146,"discounted_cash":33.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOS FEMALE/CHILD 81058","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":66.78,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOS FEMALE/CHILD 81058","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.48,"maximum":125.61,"gross_charge":126,"discounted_cash":28.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE TOTAL 70102B","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":75.26,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE TOTAL 70102B","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.48,"maximum":125.61,"gross_charge":142,"discounted_cash":32.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE TOTAL 81056B","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":54.59,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE TOTAL 81056B","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.48,"maximum":125.61,"gross_charge":103,"discounted_cash":23.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE TOTAL 81057A","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":17.16,"gross_charge":21,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-TESTOSTERONE TOTAL 81057A","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":125.61,"gross_charge":21,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"}]}]},{"description":"TESTOSTERONE TOTAL","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":217.83,"maximum":335.79,"gross_charge":411,"discounted_cash":94.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":335.79,"methodology":"fee schedule"}]}]},{"description":"TESTOSTERONE TOTAL","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.48,"maximum":335.79,"gross_charge":411,"discounted_cash":94.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":335.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"}]}]},{"description":"PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8441","type":"APR-DRG"}],"standard_charges":[{"minimum":2948,"maximum":2948,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2948,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2948,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2948,"methodology":"case rate"}]}]},{"description":"PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8442","type":"APR-DRG"}],"standard_charges":[{"minimum":5009,"maximum":5009,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5009,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5009,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5009,"methodology":"case rate"}]}]},{"description":"RL-A-VITAMIN B1 PLASMA 80389","code_information":[{"code":"84425","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN B1 PLASMA 80389","code_information":[{"code":"84425","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.73,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN B1 WHOLE BLD80388","code_information":[{"code":"84425","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":45.05,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN B1 WHOLE BLD80388","code_information":[{"code":"84425","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.73,"maximum":103.35,"gross_charge":85,"discounted_cash":19.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"}]}]},{"description":"PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8443","type":"APR-DRG"}],"standard_charges":[{"minimum":8229,"maximum":8229,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8229,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8229,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8229,"methodology":"case rate"}]}]},{"description":"RL-A-RFLX BILL TG MS 2006692","code_information":[{"code":"84432","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":33.92,"maximum":52.29,"gross_charge":64,"discounted_cash":14.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BILL TG MS 2006692","code_information":[{"code":"84432","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.63,"maximum":78.15,"gross_charge":64,"discounted_cash":14.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-THIOPURINE METHYLTR 92066","code_information":[{"code":"84433","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":102.82,"maximum":158.5,"gross_charge":194,"discounted_cash":44.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-THIOPURINE METHYLTR 92066","code_information":[{"code":"84433","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.3,"maximum":158.5,"gross_charge":194,"discounted_cash":44.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":64.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.3,"methodology":"fee schedule"}]}]},{"description":"THYROXINE TOTAL","code_information":[{"code":"84436","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":84.27,"maximum":129.91,"gross_charge":159,"discounted_cash":36.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.91,"methodology":"fee schedule"}]}]},{"description":"THYROXINE TOTAL","code_information":[{"code":"84436","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.12,"maximum":129.91,"gross_charge":159,"discounted_cash":36.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"}]}]},{"description":"THYROXINE FREE","code_information":[{"code":"84439","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":143.1,"maximum":220.59,"gross_charge":270,"discounted_cash":61.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"}]}]},{"description":"THYROXINE FREE","code_information":[{"code":"84439","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.41,"maximum":220.59,"gross_charge":270,"discounted_cash":61.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"}]}]},{"description":"PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8444","type":"APR-DRG"}],"standard_charges":[{"minimum":18462,"maximum":18462,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18462,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18462,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18462,"methodology":"case rate"}]}]},{"description":"RL-A-THYROXINE BIND GLOB 70410","code_information":[{"code":"84442","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-THYROXINE BIND GLOB 70410","code_information":[{"code":"84442","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.86,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"}]}]},{"description":"THYROID STIMULATING HORMONE","code_information":[{"code":"84443","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":203.52,"maximum":313.73,"gross_charge":384,"discounted_cash":87.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":203.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":313.73,"methodology":"fee schedule"}]}]},{"description":"THYROID STIMULATING HORMONE","code_information":[{"code":"84443","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.08,"maximum":313.73,"gross_charge":384,"discounted_cash":87.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":203.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":313.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-THRYR STIM IMMUNOG3002287","code_information":[{"code":"84445","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":166.42,"maximum":256.54,"gross_charge":314,"discounted_cash":71.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":166.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":256.54,"methodology":"fee schedule"}]}]},{"description":"RL-A-THRYR STIM IMMUNOG3002287","code_information":[{"code":"84445","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":30.51,"maximum":256.54,"gross_charge":314,"discounted_cash":71.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":166.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":256.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":51.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":52.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":50.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN E SRM/PLASM 80521","code_information":[{"code":"84446","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":46.64,"maximum":71.9,"gross_charge":88,"discounted_cash":20.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN E SRM/PLASM 80521","code_information":[{"code":"84446","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.5,"maximum":71.9,"gross_charge":88,"discounted_cash":20.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRANSFERASE ASPAR2005661A","code_information":[{"code":"84450","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRANSFERASE ASPAR2005661A","code_information":[{"code":"84450","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"TRANSFERASE ASPARTATE AST SGOT","code_information":[{"code":"84450","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":62.01,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"}]}]},{"description":"TRANSFERASE ASPARTATE AST SGOT","code_information":[{"code":"84450","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRANSFERASE ALAN 2005661B","code_information":[{"code":"84460","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRANSFERASE ALAN 2005661B","code_information":[{"code":"84460","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.18,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"}]}]},{"description":"TRANSFERASE ALANINE ALT SGPT","code_information":[{"code":"84460","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":49.82,"maximum":76.8,"gross_charge":94,"discounted_cash":21.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.8,"methodology":"fee schedule"}]}]},{"description":"TRANSFERASE ALANINE ALT SGPT","code_information":[{"code":"84460","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.18,"maximum":76.8,"gross_charge":94,"discounted_cash":21.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"}]}]},{"description":"TRANSFERRIN","code_information":[{"code":"84466","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":111.83,"maximum":172.39,"gross_charge":211,"discounted_cash":48.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"}]}]},{"description":"TRANSFERRIN","code_information":[{"code":"84466","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.65,"maximum":172.39,"gross_charge":211,"discounted_cash":48.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"}]}]},{"description":"TRIGLYCERIDES","code_information":[{"code":"84478","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"TRIGLYCERIDES","code_information":[{"code":"84478","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.44,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"}]}]},{"description":"TRIIODOTHYRONINE T3 TOTAL","code_information":[{"code":"84480","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":135.15,"maximum":208.34,"gross_charge":255,"discounted_cash":58.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.34,"methodology":"fee schedule"}]}]},{"description":"TRIIODOTHYRONINE T3 TOTAL","code_information":[{"code":"84480","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.5,"maximum":208.34,"gross_charge":255,"discounted_cash":58.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"}]}]},{"description":"TRIIODOTHYRONINE FREE","code_information":[{"code":"84481","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":125.61,"maximum":193.63,"gross_charge":237,"discounted_cash":54.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.63,"methodology":"fee schedule"}]}]},{"description":"TRIIODOTHYRONINE FREE","code_information":[{"code":"84481","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.16,"maximum":193.63,"gross_charge":237,"discounted_cash":54.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRIIODOTHY REVERSE2007918","code_information":[{"code":"84482","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.94,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRIIODOTHY REVERSE2007918","code_information":[{"code":"84482","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.45,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"}]}]},{"description":"TROPONIN QUANTITATIVE","code_information":[{"code":"84484","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":118.72,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"}]}]},{"description":"TROPONIN QUANTITATIVE","code_information":[{"code":"84484","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.48,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"}]}]},{"description":"CAPD/HOME/SUPSERV","code_information":[{"code":"845","type":"RC"}],"standard_charges":[{"minimum":593.2,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":593.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":593.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"minimum":7744.29,"maximum":35869.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16265,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16265,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35869.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26902.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26902.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15737.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12978.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17863.51,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7744.29,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7821.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7976.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7899.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7744.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7744.29,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7744.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7937.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7744.29,"methodology":"case rate"}]}]},{"description":"TROPONIN QUALITATIVE","code_information":[{"code":"84512","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"TROPONIN QUALITATIVE","code_information":[{"code":"84512","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.05,"maximum":49.1,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-UREA NITROGEN FLUID 20183","code_information":[{"code":"84520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.78,"maximum":21.25,"gross_charge":26,"discounted_cash":5.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-UREA NITROGEN FLUID 20183","code_information":[{"code":"84520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":21.25,"gross_charge":26,"discounted_cash":5.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-UREA NITROGEN QN 2005661D","code_information":[{"code":"84520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":66.78,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-UREA NITROGEN QN 2005661D","code_information":[{"code":"84520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"UREA NITROGEN BLOOD (BUN)","code_information":[{"code":"84520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"UREA NITROGEN BLOOD (BUN)","code_information":[{"code":"84520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"UREA NITROGEN BLOOD (BUN) QW","code_information":[{"code":"84520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.48,"maximum":13.08,"gross_charge":16,"discounted_cash":3.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"}]}]},{"description":"UREA NITROGEN BLOOD (BUN) QW","code_information":[{"code":"84520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":19.25,"gross_charge":16,"discounted_cash":3.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"UREA NITROGEN URINE","code_information":[{"code":"84540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":80.03,"maximum":123.37,"gross_charge":151,"discounted_cash":34.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.37,"methodology":"fee schedule"}]}]},{"description":"UREA NITROGEN URINE","code_information":[{"code":"84540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.33,"maximum":123.37,"gross_charge":151,"discounted_cash":34.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"}]}]},{"description":"URIC ACID BLOOD","code_information":[{"code":"84550","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":78.97,"maximum":121.74,"gross_charge":149,"discounted_cash":34.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"}]}]},{"description":"URIC ACID BLOOD","code_information":[{"code":"84550","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.71,"maximum":121.74,"gross_charge":149,"discounted_cash":34.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-URIC ACID BODY FLD 20513","code_information":[{"code":"84560","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-URIC ACID BODY FLD 20513","code_information":[{"code":"84560","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.04,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"}]}]},{"description":"URIC ACID OTHER SOURCE","code_information":[{"code":"84560","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.69,"maximum":59.65,"gross_charge":73,"discounted_cash":16.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"}]}]},{"description":"URIC ACID OTHER SOURCE","code_information":[{"code":"84560","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.04,"maximum":59.65,"gross_charge":73,"discounted_cash":16.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-VANILLYLMAND ACID U 80421","code_information":[{"code":"84585","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-VANILLYLMAND ACID U 80421","code_information":[{"code":"84585","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":75.43,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-VMA URINE 80470B","code_information":[{"code":"84585","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.41,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-VMA URINE 80470B","code_information":[{"code":"84585","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-COPEPTIN PLASMA 3018705","code_information":[{"code":"84588","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":95.4,"maximum":147.06,"gross_charge":180,"discounted_cash":41.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-COPEPTIN PLASMA 3018705","code_information":[{"code":"84588","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":20.36,"maximum":165.18,"gross_charge":180,"discounted_cash":41.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":165.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":99.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN A SRM/PLASM 80525","code_information":[{"code":"84590","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":96.99,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN A SRM/PLASM 80525","code_information":[{"code":"84590","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.96,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN K1 SERUM 99225","code_information":[{"code":"84597","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":184.44,"maximum":284.32,"gross_charge":348,"discounted_cash":79.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":184.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":284.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-VITAMIN K1 SERUM 99225","code_information":[{"code":"84597","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.23,"maximum":284.32,"gross_charge":348,"discounted_cash":79.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":184.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":284.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"minimum":16763.68,"maximum":54186.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49340,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49340,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22351.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16763.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16763.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":47738.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":39367.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54186.75,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21021.88,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21232.1,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21652.54,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21442.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21021.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21021.88,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21021.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21547.43,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21021.88,"methodology":"case rate"}]}]},{"description":"RL-A-ZINC QN WHOLE BLD 2009373","code_information":[{"code":"84630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.45,"maximum":53.11,"gross_charge":65,"discounted_cash":14.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZINC QN WHOLE BLD 2009373","code_information":[{"code":"84630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.83,"maximum":55.47,"gross_charge":65,"discounted_cash":14.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZINC SERUM/PLASMA 20097","code_information":[{"code":"84630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZINC SERUM/PLASMA 20097","code_information":[{"code":"84630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.83,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-C-PEPTIDE SER/PLASM 70103","code_information":[{"code":"84681","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":157.41,"maximum":242.65,"gross_charge":297,"discounted_cash":68.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-C-PEPTIDE SER/PLASM 70103","code_information":[{"code":"84681","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":242.65,"gross_charge":297,"discounted_cash":68.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"minimum":11099.65,"maximum":27147.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24719,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24719,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19790,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14842.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14842.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23916.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19722.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27147.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11210.65,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11432.64,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11321.65,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11377.15,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11099.65,"methodology":"case rate"}]}]},{"description":"HCG QN","code_information":[{"code":"84702","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":178.61,"maximum":275.33,"gross_charge":337,"discounted_cash":77.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":275.33,"methodology":"fee schedule"}]}]},{"description":"HCG QN","code_information":[{"code":"84702","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":275.33,"gross_charge":337,"discounted_cash":77.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":275.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-HCG QN 70029","code_information":[{"code":"84702","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-HCG QN 70029","code_information":[{"code":"84702","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":73.22,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-BHCG QUANT CSF 20730","code_information":[{"code":"84702","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.88,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-BHCG QUANT CSF 20730","code_information":[{"code":"84702","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"HCG QL (PREG TEST)","code_information":[{"code":"84703","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":147.34,"maximum":227.13,"gross_charge":278,"discounted_cash":63.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.13,"methodology":"fee schedule"}]}]},{"description":"HCG QL (PREG TEST)","code_information":[{"code":"84703","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.51,"maximum":227.13,"gross_charge":278,"discounted_cash":63.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"minimum":7605.87,"maximum":25448.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18435,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18435,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25448.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19086.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19086.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17836.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14709.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20246.28,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7605.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7681.93,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7834.05,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7757.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7605.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7605.87,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7605.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7796.02,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7605.87,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"849","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"minimum":21928.97,"maximum":114905.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39933,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39933,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114905.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":86180.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":86180.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":38636.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":31861.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43855.25,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21928.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22148.26,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22586.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22367.55,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21928.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21928.97,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21928.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22477.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21928.97,"methodology":"case rate"}]}]},{"description":"ONCOTYPE DX BREAST GENOMIC","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8123.84,"maximum":12522.98,"gross_charge":15328,"discounted_cash":3510.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8123.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12522.98,"methodology":"fee schedule"}]}]},{"description":"ONCOTYPE DX BREAST GENOMIC","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":77.97,"maximum":12522.98,"gross_charge":15328,"discounted_cash":3510.12,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8123.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12522.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2145.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2145.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2145.92,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM BODY FLUID","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":245.92,"maximum":379.09,"gross_charge":464,"discounted_cash":106.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.09,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM BODY FLUID","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.96,"maximum":379.09,"gross_charge":464,"discounted_cash":106.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-OSMOLALITY FECAL 98122","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-OSMOLALITY FECAL 98122","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.52,"maximum":103.95,"gross_charge":18,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-POTASSIUM FECAL 20380","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":17.16,"gross_charge":21,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-POTASSIUM FECAL 20380","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.94,"maximum":103.95,"gross_charge":21,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-POTASSIUM FLUID 20155","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":227.37,"maximum":350.5,"gross_charge":429,"discounted_cash":98.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-POTASSIUM FLUID 20155","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":60.06,"maximum":350.5,"gross_charge":429,"discounted_cash":98.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-UNLISTED CHEMISTRY 60185C","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.6,"maximum":16.34,"gross_charge":20,"discounted_cash":4.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-UNLISTED CHEMISTRY 60185C","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":2.8,"maximum":103.95,"gross_charge":20,"discounted_cash":4.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"}]}]},{"description":"ACUTE LEUKEMIA WITH OTHER PROCEDURES","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"minimum":72509.1,"maximum":110160.17,"setting":"inpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110160.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":82621.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":82621.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":72509.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":73234.2,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":74684.38,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":73959.29,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":72509.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":72509.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":72509.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":74321.83,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":72509.1,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"850","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"BLEEDING TIME","code_information":[{"code":"85002","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":141.51,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"}]}]},{"description":"BLEEDING TIME","code_information":[{"code":"85002","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.89,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT MANUAL DIFF WBC","code_information":[{"code":"85007","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT MANUAL DIFF WBC","code_information":[{"code":"85007","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.28,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"}]}]},{"description":"PROCEDURE WITH DIAGNOSIS OF REHABILITATION AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES","code_information":[{"code":"8501","type":"APR-DRG"}],"standard_charges":[{"minimum":10690,"maximum":10690,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10690,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10690,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10690,"methodology":"case rate"}]}]},{"description":"BLOOD COUNT HEMATOCRIT","code_information":[{"code":"85014","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT HEMATOCRIT","code_information":[{"code":"85014","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":1.42,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT HEMOGLOBIN","code_information":[{"code":"85018","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT HEMOGLOBIN","code_information":[{"code":"85018","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":1.42,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"}]}]},{"description":"PROCEDURE WITH DIAGNOSIS OF REHABILITATION AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES","code_information":[{"code":"8502","type":"APR-DRG"}],"standard_charges":[{"minimum":14639,"maximum":14639,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14639,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14639,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14639,"methodology":"case rate"}]}]},{"description":"CBC AUTO W AUTO DIF","code_information":[{"code":"85025","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"CBC AUTO W AUTO DIF","code_information":[{"code":"85025","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":4.66,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"}]}]},{"description":"CBC AUTO WO DIFF","code_information":[{"code":"85027","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":100.7,"maximum":155.23,"gross_charge":190,"discounted_cash":43.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.23,"methodology":"fee schedule"}]}]},{"description":"CBC AUTO WO DIFF","code_information":[{"code":"85027","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.88,"maximum":155.23,"gross_charge":190,"discounted_cash":43.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"}]}]},{"description":"PROCEDURE WITH DIAGNOSIS OF REHABILITATION AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES","code_information":[{"code":"8503","type":"APR-DRG"}],"standard_charges":[{"minimum":18923,"maximum":18923,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18923,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18923,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18923,"methodology":"case rate"}]}]},{"description":"BLOOD COUNT MANUAL CELL CT","code_information":[{"code":"85032","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.01,"maximum":13.89,"gross_charge":17,"discounted_cash":3.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT MANUAL CELL CT","code_information":[{"code":"85032","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.58,"maximum":20.97,"gross_charge":17,"discounted_cash":3.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"}]}]},{"description":"PROCEDURE WITH DIAGNOSIS OF REHABILITATION AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES","code_information":[{"code":"8504","type":"APR-DRG"}],"standard_charges":[{"minimum":42492,"maximum":42492,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42492,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42492,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42492,"methodology":"case rate"}]}]},{"description":"BLOOD COUNT RETICULOCYTE AUTO","code_information":[{"code":"85045","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT RETICULOCYTE AUTO","code_information":[{"code":"85045","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.39,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT EOSINOPHIL AUTO","code_information":[{"code":"85048","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":55.12,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT EOSINOPHIL AUTO","code_information":[{"code":"85048","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":1.52,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT LEUKOCYTE AUTO","code_information":[{"code":"85048","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT LEUKOCYTE AUTO","code_information":[{"code":"85048","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":1.52,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT PLATELET AUTO","code_information":[{"code":"85049","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":70.49,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"}]}]},{"description":"BLOOD COUNT PLATELET AUTO","code_information":[{"code":"85049","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.68,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"}]}]},{"description":"BONE MARROW SMEAR INTERP","code_information":[{"code":"85097","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":824.15,"maximum":1270.44,"gross_charge":1555,"discounted_cash":356.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":824.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1270.44,"methodology":"fee schedule"}]}]},{"description":"BONE MARROW SMEAR INTERP","code_information":[{"code":"85097","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":49.71,"maximum":1270.44,"gross_charge":1555,"discounted_cash":356.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":91.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":91.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":139.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":824.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1270.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":896.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":888.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":892.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"}]}]},{"description":"CAPD/COMPOSITE","code_information":[{"code":"851","type":"RC"}],"standard_charges":[{"minimum":519.05,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":691.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":519.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":519.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"852","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-FACTOR II ACTIVITY 30007","code_information":[{"code":"85210","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":50.35,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR II ACTIVITY 30007","code_information":[{"code":"85210","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7.78,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR V LIABLE","code_information":[{"code":"85220","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":526.29,"maximum":811.29,"gross_charge":993,"discounted_cash":227.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":526.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":811.29,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR V LIABLE","code_information":[{"code":"85220","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":10.59,"maximum":811.29,"gross_charge":993,"discounted_cash":227.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":36.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":36.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":51.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":526.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":811.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.65,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR VII STABLE","code_information":[{"code":"85230","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":526.29,"maximum":811.29,"gross_charge":993,"discounted_cash":227.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":526.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":811.29,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR VII STABLE","code_information":[{"code":"85230","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":811.29,"gross_charge":993,"discounted_cash":227.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":526.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":811.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR VIII AHG","code_information":[{"code":"85240","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":441.49,"maximum":680.57,"gross_charge":833,"discounted_cash":190.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":441.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":680.57,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR VIII AHG","code_information":[{"code":"85240","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":680.57,"gross_charge":833,"discounted_cash":190.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":441.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":680.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAC 8 RFLX BETHESDA 30026","code_information":[{"code":"85240","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAC 8 RFLX BETHESDA 30026","code_information":[{"code":"85240","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-VW RISTOCETIN COFAC 30250","code_information":[{"code":"85245","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":75.26,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-VW RISTOCETIN COFAC 30250","code_information":[{"code":"85245","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":13.76,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAC VIII VW FAC AG 30002A","code_information":[{"code":"85246","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":75.26,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAC VIII VW FAC AG 30002A","code_information":[{"code":"85246","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":13.76,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-VON WILLEBRAND AG 30285","code_information":[{"code":"85246","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":79.5,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-VON WILLEBRAND AG 30285","code_information":[{"code":"85246","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":13.76,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAC VIII VW MULTIM 30002B","code_information":[{"code":"85247","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":75.26,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-FAC VIII VW MULTIM 30002B","code_information":[{"code":"85247","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":13.76,"maximum":116.02,"gross_charge":142,"discounted_cash":32.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR IX CHRISTM/PTC","code_information":[{"code":"85250","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":489.19,"maximum":754.1,"gross_charge":923,"discounted_cash":211.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":489.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":754.1,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR IX CHRISTM/PTC","code_information":[{"code":"85250","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":11.42,"maximum":754.1,"gross_charge":923,"discounted_cash":211.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":55.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":489.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":754.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR X STUART PROWR","code_information":[{"code":"85260","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":337.08,"maximum":519.62,"gross_charge":636,"discounted_cash":145.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":337.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"}]}]},{"description":"CLOTTING FACTOR X STUART PROWR","code_information":[{"code":"85260","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":519.62,"gross_charge":636,"discounted_cash":145.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":337.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":519.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR XI ACTIVITY 30110","code_information":[{"code":"85270","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR XI ACTIVITY 30110","code_information":[{"code":"85270","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR XII ACTIVITY 30115","code_information":[{"code":"85280","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":63.07,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR XII ACTIVITY 30115","code_information":[{"code":"85280","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":11.61,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR XIII ACTIV 2006182","code_information":[{"code":"85290","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":393.79,"maximum":607.04,"gross_charge":743,"discounted_cash":170.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":393.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":607.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR XIII ACTIV 2006182","code_information":[{"code":"85290","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.8,"maximum":607.04,"gross_charge":743,"discounted_cash":170.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":393.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":607.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR 13 QUAL 3016927","code_information":[{"code":"85291","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":19.61,"maximum":30.23,"gross_charge":37,"discounted_cash":8.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR 13 QUAL 3016927","code_information":[{"code":"85291","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":5.46,"maximum":44.3,"gross_charge":37,"discounted_cash":8.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR XIII QL 2002819","code_information":[{"code":"85291","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":19.08,"maximum":29.42,"gross_charge":36,"discounted_cash":8.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-FACTOR XIII QL 2002819","code_information":[{"code":"85291","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":5.46,"maximum":44.3,"gross_charge":36,"discounted_cash":8.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"minimum":39948.45,"maximum":105184.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95777,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95777,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76581.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":57437.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":57437.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":92667.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":76417.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":105184.11,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":39948.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":40347.94,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41146.91,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":40747.42,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":39948.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":39948.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":39948.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":40947.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":39948.45,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"853","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-ANTITHRO ENZYM ACT 30010","code_information":[{"code":"85300","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":278.25,"maximum":428.93,"gross_charge":525,"discounted_cash":120.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":278.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":428.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTITHRO ENZYM ACT 30010","code_information":[{"code":"85300","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7.11,"maximum":428.93,"gross_charge":525,"discounted_cash":120.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":278.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":428.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"}]}]},{"description":"ANTITHROMBIN III ANTIGEN","code_information":[{"code":"85301","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":199.28,"maximum":307.2,"gross_charge":376,"discounted_cash":86.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":199.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":307.2,"methodology":"fee schedule"}]}]},{"description":"ANTITHROMBIN III ANTIGEN","code_information":[{"code":"85301","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":6.48,"maximum":307.2,"gross_charge":376,"discounted_cash":86.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":199.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":307.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTITHROMBIN AG 30015","code_information":[{"code":"85301","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":23.85,"maximum":36.77,"gross_charge":45,"discounted_cash":10.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTITHROMBIN AG 30015","code_information":[{"code":"85301","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":6.48,"maximum":52.6,"gross_charge":45,"discounted_cash":10.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN C TOTAL AG 30111","code_information":[{"code":"85302","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN C TOTAL AG 30111","code_information":[{"code":"85302","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":58.47,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"}]}]},{"description":"PROTEIN C ACTIVITY","code_information":[{"code":"85303","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":121.37,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"}]}]},{"description":"PROTEIN C ACTIVITY","code_information":[{"code":"85303","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":8.3,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN C FUNCTION 30113","code_information":[{"code":"85303","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN C FUNCTION 30113","code_information":[{"code":"85303","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":8.3,"maximum":67.35,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN S TOTAL AG 30112","code_information":[{"code":"85305","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":35.51,"maximum":54.74,"gross_charge":67,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN S TOTAL AG 30112","code_information":[{"code":"85305","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":6.96,"maximum":56.47,"gross_charge":67,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"}]}]},{"description":"PROTEIN S FREE","code_information":[{"code":"85306","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":198.75,"maximum":306.38,"gross_charge":375,"discounted_cash":85.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":198.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306.38,"methodology":"fee schedule"}]}]},{"description":"PROTEIN S FREE","code_information":[{"code":"85306","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.19,"maximum":306.38,"gross_charge":375,"discounted_cash":85.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":198.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN S FREE AG 98894","code_information":[{"code":"85306","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":93.28,"maximum":143.8,"gross_charge":176,"discounted_cash":40.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN S FREE AG 98894","code_information":[{"code":"85306","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.19,"maximum":143.8,"gross_charge":176,"discounted_cash":40.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN S FUNCTION 30114","code_information":[{"code":"85306","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":32.33,"maximum":49.84,"gross_charge":61,"discounted_cash":13.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTEIN S FUNCTION 30114","code_information":[{"code":"85306","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.19,"maximum":74.58,"gross_charge":61,"discounted_cash":13.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-APC RESIS PROF RLFX 30192","code_information":[{"code":"85307","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":118.72,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-APC RESIS PROF RLFX 30192","code_information":[{"code":"85307","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.19,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-APC RESIST PROFILE 30127","code_information":[{"code":"85307","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":50.35,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"}]}]},{"description":"RL-A-APC RESIST PROFILE 30127","code_information":[{"code":"85307","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.19,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"ACT","code_information":[{"code":"85347","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":17.98,"gross_charge":22,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"ACT","code_information":[{"code":"85347","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.56,"maximum":20.83,"gross_charge":22,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"}]}]},{"description":"FDP FSP AGGLUTINATION SEMIQN","code_information":[{"code":"85362","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"FDP FSP AGGLUTINATION SEMIQN","code_information":[{"code":"85362","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":4.13,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"FIBRIN DEGRADATION D DIMER QN","code_information":[{"code":"85379","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":232.14,"maximum":357.85,"gross_charge":438,"discounted_cash":100.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":232.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":357.85,"methodology":"fee schedule"}]}]},{"description":"FIBRIN DEGRADATION D DIMER QN","code_information":[{"code":"85379","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":6.1,"maximum":357.85,"gross_charge":438,"discounted_cash":100.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":232.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":357.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"}]}]},{"description":"FIBRINOGEN ACTIVITY","code_information":[{"code":"85384","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":132.5,"maximum":204.25,"gross_charge":250,"discounted_cash":57.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":132.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204.25,"methodology":"fee schedule"}]}]},{"description":"FIBRINOGEN ACTIVITY","code_information":[{"code":"85384","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":5.83,"maximum":204.25,"gross_charge":250,"discounted_cash":57.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":132.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"}]}]},{"description":"FIBRINOLYSINS SCR INTERP RPT","code_information":[{"code":"85390","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":45.05,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"}]}]},{"description":"FIBRINOLYSINS SCR INTERP RPT","code_information":[{"code":"85390","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.28,"maximum":92.64,"gross_charge":85,"discounted_cash":19.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADAMTS 13 ACTIVITY 30056","code_information":[{"code":"85397","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":71.02,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADAMTS 13 ACTIVITY 30056","code_information":[{"code":"85397","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":18.51,"maximum":150.15,"gross_charge":134,"discounted_cash":30.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":90.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":30.86,"methodology":"fee schedule"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"minimum":16724.65,"maximum":52434.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40598,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40598,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52434.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39326.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39326.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39279.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32392.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44585.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16724.65,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16891.9,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17226.39,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17059.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16724.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16724.65,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16724.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17142.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16724.65,"methodology":"case rate"}]}]},{"description":"PERITONEAL DIALYSIS CAPD CCD","code_information":[{"code":"854","type":"RC"}],"standard_charges":[{"minimum":723,"maximum":874,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":874,"methodology":"case rate"}]}]},{"description":"RL-A-PLASMINOGEN AC INH1 98781","code_information":[{"code":"85415","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":130.91,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-PLASMINOGEN AC INH1 98781","code_information":[{"code":"85415","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":10.31,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-PLASMINOGEN ACTIV 30190","code_information":[{"code":"85420","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":21.73,"maximum":33.5,"gross_charge":41,"discounted_cash":9.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-PLASMINOGEN ACTIV 30190","code_information":[{"code":"85420","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.91,"maximum":33.5,"gross_charge":41,"discounted_cash":9.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEINZ BODY DIRECT 49090A","code_information":[{"code":"85441","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":20.43,"gross_charge":25,"discounted_cash":5.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEINZ BODY DIRECT 49090A","code_information":[{"code":"85441","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.52,"maximum":20.47,"gross_charge":25,"discounted_cash":5.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEINZ BODY INDUCED 49090B","code_information":[{"code":"85445","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":20.43,"gross_charge":25,"discounted_cash":5.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEINZ BODY INDUCED 49090B","code_information":[{"code":"85445","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":4.09,"maximum":33.21,"gross_charge":25,"discounted_cash":5.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"}]}]},{"description":"HGB FETAL KLEIHAUER BETKE","code_information":[{"code":"85460","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":177.02,"maximum":272.88,"gross_charge":334,"discounted_cash":76.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.88,"methodology":"fee schedule"}]}]},{"description":"HGB FETAL KLEIHAUER BETKE","code_information":[{"code":"85460","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":4.63,"maximum":272.88,"gross_charge":334,"discounted_cash":76.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":177.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"minimum":13844.1,"maximum":72691.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30117,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30117,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72691.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54519.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54519.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29139.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24030.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33076.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13844.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13982.55,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14259.43,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14120.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13844.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13844.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13844.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14190.21,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13844.1,"methodology":"case rate"}]}]},{"description":"HEPARIN ASSAY","code_information":[{"code":"85520","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":87.98,"maximum":135.63,"gross_charge":166,"discounted_cash":38.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.63,"methodology":"fee schedule"}]}]},{"description":"HEPARIN ASSAY","code_information":[{"code":"85520","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7.85,"maximum":135.63,"gross_charge":166,"discounted_cash":38.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPARIN ANTIXA LMWH 30144","code_information":[{"code":"85520","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":379.48,"maximum":584.98,"gross_charge":716,"discounted_cash":163.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":379.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":584.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPARIN ANTIXA LMWH 30144","code_information":[{"code":"85520","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7.85,"maximum":584.98,"gross_charge":716,"discounted_cash":163.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":379.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":584.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"}]}]},{"description":"HEPARIN NEUTRALIZATION","code_information":[{"code":"85525","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":165.36,"maximum":254.91,"gross_charge":312,"discounted_cash":71.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.91,"methodology":"fee schedule"}]}]},{"description":"HEPARIN NEUTRALIZATION","code_information":[{"code":"85525","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7.1,"maximum":254.91,"gross_charge":312,"discounted_cash":71.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-LYSOZYME SERUM 2012039","code_information":[{"code":"85549","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-LYSOZYME SERUM 2012039","code_information":[{"code":"85549","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":11.25,"maximum":91.25,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":54.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-OSMOTIC FRAG ERYTH2002257","code_information":[{"code":"85555","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":21.73,"maximum":33.5,"gross_charge":41,"discounted_cash":9.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-OSMOTIC FRAG ERYTH2002257","code_information":[{"code":"85555","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":4.48,"maximum":36.36,"gross_charge":41,"discounted_cash":9.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.7,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"}]}]},{"description":"PLATELET AGGREGATION EA","code_information":[{"code":"85576","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":66.25,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"}]}]},{"description":"PLATELET AGGREGATION EA","code_information":[{"code":"85576","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":14.94,"maximum":121.24,"gross_charge":125,"discounted_cash":28.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":72.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":25.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX HEX PHOS BILL 30081","code_information":[{"code":"85598","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":55.65,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX HEX PHOS BILL 30081","code_information":[{"code":"85598","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":10.78,"maximum":87.53,"gross_charge":105,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"minimum":34607.21,"maximum":91302.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83136,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83136,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46142.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34607.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34607.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80437.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":66332.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":91302.19,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":36161.59,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":36523.21,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":37246.44,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":36884.83,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":36161.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":36161.59,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":36161.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":37065.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":36161.59,"methodology":"case rate"}]}]},{"description":"PROTHROMBIN TIME","code_information":[{"code":"85610","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":103.88,"maximum":160.14,"gross_charge":196,"discounted_cash":44.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"}]}]},{"description":"PROTHROMBIN TIME","code_information":[{"code":"85610","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.57,"maximum":160.14,"gross_charge":196,"discounted_cash":44.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-INHIBITOR ASSAY PT2003260","code_information":[{"code":"85610","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-INHIBITOR ASSAY PT2003260","code_information":[{"code":"85610","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.57,"maximum":20.9,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTHROMBIN TIME 3017009A","code_information":[{"code":"85610","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.01,"maximum":13.89,"gross_charge":17,"discounted_cash":3.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTHROMBIN TIME 3017009A","code_information":[{"code":"85610","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.57,"maximum":20.9,"gross_charge":17,"discounted_cash":3.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"}]}]},{"description":"PROTHROMBIN TIME SUBSTITUTION","code_information":[{"code":"85611","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"PROTHROMBIN TIME SUBSTITUTION","code_information":[{"code":"85611","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.36,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX PT INHIB 1:1 2003264","code_information":[{"code":"85611","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":19.08,"maximum":29.42,"gross_charge":36,"discounted_cash":8.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX PT INHIB 1:1 2003264","code_information":[{"code":"85611","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.36,"maximum":29.42,"gross_charge":36,"discounted_cash":8.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-RUSSEL VIPER VEN 3017009B","code_information":[{"code":"85613","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":31.87,"gross_charge":39,"discounted_cash":8.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-RUSSEL VIPER VEN 3017009B","code_information":[{"code":"85613","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":5.74,"maximum":46.59,"gross_charge":39,"discounted_cash":8.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"}]}]},{"description":"RUSSELL VIPER VENOM DILUTED","code_information":[{"code":"85613","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":98.05,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"}]}]},{"description":"RUSSELL VIPER VENOM DILUTED","code_information":[{"code":"85613","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":5.74,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"}]}]},{"description":"SED RATE RBC NON AUTO","code_information":[{"code":"85651","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":22.26,"maximum":34.32,"gross_charge":42,"discounted_cash":9.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"}]}]},{"description":"SED RATE RBC NON AUTO","code_information":[{"code":"85651","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.56,"maximum":34.32,"gross_charge":42,"discounted_cash":9.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"SED RATE RBC AUTO","code_information":[{"code":"85652","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":84.8,"maximum":130.72,"gross_charge":160,"discounted_cash":36.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"}]}]},{"description":"SED RATE RBC AUTO","code_information":[{"code":"85652","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":1.62,"maximum":130.72,"gross_charge":160,"discounted_cash":36.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL SICKLE SOL BILL 81271","code_information":[{"code":"85660","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7.42,"maximum":11.44,"gross_charge":14,"discounted_cash":3.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL SICKLE SOL BILL 81271","code_information":[{"code":"85660","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.3,"maximum":26.84,"gross_charge":14,"discounted_cash":3.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"}]}]},{"description":"SICKLE CELL RBC REDUCTION","code_information":[{"code":"85660","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":60.42,"maximum":93.14,"gross_charge":114,"discounted_cash":26.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"}]}]},{"description":"SICKLE CELL RBC REDUCTION","code_information":[{"code":"85660","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.3,"maximum":93.14,"gross_charge":114,"discounted_cash":26.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX THROMBIN TIME 30087","code_information":[{"code":"85670","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":18.02,"maximum":27.78,"gross_charge":34,"discounted_cash":7.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX THROMBIN TIME 30087","code_information":[{"code":"85670","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.46,"maximum":28.06,"gross_charge":34,"discounted_cash":7.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-THROMBIN TIME REFLX 30260","code_information":[{"code":"85670","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":18.55,"maximum":28.6,"gross_charge":35,"discounted_cash":8.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-THROMBIN TIME REFLX 30260","code_information":[{"code":"85670","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.46,"maximum":28.6,"gross_charge":35,"discounted_cash":8.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"}]}]},{"description":"THROMBIN TIME PLASMA","code_information":[{"code":"85670","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":37.1,"maximum":57.19,"gross_charge":70,"discounted_cash":16.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"}]}]},{"description":"THROMBIN TIME PLASMA","code_information":[{"code":"85670","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.46,"maximum":57.19,"gross_charge":70,"discounted_cash":16.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"}]}]},{"description":"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"minimum":18122.77,"maximum":41946.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38195,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38195,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35378.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26534.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26534.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":36955.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30475.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41946.97,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18122.77,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18304,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18666.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18485.23,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18122.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18122.77,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18122.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18575.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18122.77,"methodology":"case rate"}]}]},{"description":"PARTIAL THROMBO TIME","code_information":[{"code":"85730","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":151.58,"maximum":233.67,"gross_charge":286,"discounted_cash":65.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":151.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":233.67,"methodology":"fee schedule"}]}]},{"description":"PARTIAL THROMBO TIME","code_information":[{"code":"85730","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.6,"maximum":233.67,"gross_charge":286,"discounted_cash":65.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":151.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":233.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-INHIBIT ASSAY PTT 2003266","code_information":[{"code":"85730","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":12.19,"maximum":18.8,"gross_charge":23,"discounted_cash":5.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-INHIBIT ASSAY PTT 2003266","code_information":[{"code":"85730","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.6,"maximum":29.27,"gross_charge":23,"discounted_cash":5.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-PART THROM TIME 3017009C","code_information":[{"code":"85730","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-PART THROM TIME 3017009C","code_information":[{"code":"85730","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.6,"maximum":29.27,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"}]}]},{"description":"PTT SUBSTITUTION","code_information":[{"code":"85732","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":200.87,"maximum":309.65,"gross_charge":379,"discounted_cash":86.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":200.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":309.65,"methodology":"fee schedule"}]}]},{"description":"PTT SUBSTITUTION","code_information":[{"code":"85732","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.88,"maximum":309.65,"gross_charge":379,"discounted_cash":86.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":200.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":309.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX INPTT 1:1MIX 2003270","code_information":[{"code":"85732","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":19.08,"maximum":29.42,"gross_charge":36,"discounted_cash":8.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX INPTT 1:1MIX 2003270","code_information":[{"code":"85732","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.88,"maximum":31.49,"gross_charge":36,"discounted_cash":8.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"}]}]},{"description":"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"minimum":11236.52,"maximum":30924.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25855,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25855,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30924.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23193.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23193.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25016.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20629.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28395.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11236.52,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11348.89,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11573.62,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11461.26,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11236.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11236.52,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11236.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11517.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11236.52,"methodology":"case rate"}]}]},{"description":"RL-A-VISCOSITY SERUM 20056","code_information":[{"code":"85810","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":116.07,"maximum":178.93,"gross_charge":219,"discounted_cash":50.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":116.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-VISCOSITY SERUM 20056","code_information":[{"code":"85810","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7,"maximum":178.93,"gross_charge":219,"discounted_cash":50.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":34.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":116.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"}]}]},{"description":"MEG","code_information":[{"code":"860","type":"RC"}],"standard_charges":[{"minimum":5106,"maximum":5819,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":5819,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5106,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5779,"methodology":"case rate"}]}]},{"description":"RL-A-ALL IGE QN/SEMIQN3001561A","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALL IGE QN/SEMIQN3001561A","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":3.13,"maximum":25.41,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALL IGE QN/SEMIQN3001721A","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":17.16,"gross_charge":21,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALL IGE QN/SEMIQN3001721A","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":3.13,"maximum":25.41,"gross_charge":21,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLER IGE QN/SEMIQN50486B","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLER IGE QN/SEMIQN50486B","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":3.13,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLERG FOOD PAN 8 55133","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLERG FOOD PAN 8 55133","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":3.13,"maximum":25.41,"gross_charge":18,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLERGEN PED FOOD 1 55121","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":310.05,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLERGEN PED FOOD 1 55121","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":3.13,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALL IGE QL MULTI 3001561B","code_information":[{"code":"86005","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALL IGE QL MULTI 3001561B","code_information":[{"code":"86005","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":4.78,"maximum":38.79,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLERG FEATHER MIX 55037","code_information":[{"code":"86005","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLERG FEATHER MIX 55037","code_information":[{"code":"86005","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":4.78,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLERGEN CASEIN 55081","code_information":[{"code":"86008","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALLERGEN CASEIN 55081","code_information":[{"code":"86008","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.75,"maximum":87.24,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"}]}]},{"description":"REHABILITATION","code_information":[{"code":"8601","type":"APR-DRG"}],"standard_charges":[{"minimum":7086,"maximum":7086,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7086,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7086,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7086,"methodology":"case rate"}]}]},{"description":"RL-A-F ACTIN IGG ELISA 51174","code_information":[{"code":"86015","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":129.85,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-F ACTIN IGG ELISA 51174","code_information":[{"code":"86015","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"REHABILITATION","code_information":[{"code":"8602","type":"APR-DRG"}],"standard_charges":[{"minimum":9310,"maximum":9310,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9310,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9310,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9310,"methodology":"case rate"}]}]},{"description":"RL-A-NEUTROPHIL ASSOC AB 55506","code_information":[{"code":"86021","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":127.73,"maximum":196.9,"gross_charge":241,"discounted_cash":55.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEUTROPHIL ASSOC AB 55506","code_information":[{"code":"86021","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":196.9,"gross_charge":241,"discounted_cash":55.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"PLATELET ANTIBODY ID","code_information":[{"code":"86022","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":209.88,"maximum":323.54,"gross_charge":396,"discounted_cash":90.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":209.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":323.54,"methodology":"fee schedule"}]}]},{"description":"PLATELET ANTIBODY ID","code_information":[{"code":"86022","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.02,"maximum":323.54,"gross_charge":396,"discounted_cash":90.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":209.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":323.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"}]}]},{"description":"RL-A- SERATONIN REL AB 2005631","code_information":[{"code":"86022","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":721.86,"maximum":1112.76,"gross_charge":1362,"discounted_cash":311.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":721.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1112.76,"methodology":"fee schedule"}]}]},{"description":"RL-A- SERATONIN REL AB 2005631","code_information":[{"code":"86022","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.02,"maximum":1112.76,"gross_charge":1362,"discounted_cash":311.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":721.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1112.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"}]}]},{"description":"RL-A-PLATELET ASSOC AB 95614","code_information":[{"code":"86023","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":25.44,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-PLATELET ASSOC AB 95614","code_information":[{"code":"86023","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.47,"maximum":60.62,"gross_charge":48,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"}]}]},{"description":"REHABILITATION","code_information":[{"code":"8603","type":"APR-DRG"}],"standard_charges":[{"minimum":11912,"maximum":11912,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11912,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11912,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11912,"methodology":"case rate"}]}]},{"description":"RL-A-ANCA IGG BY IFA 3003747","code_information":[{"code":"86036","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANCA IGG BY IFA 3003747","code_information":[{"code":"86036","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":58.62,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-FLUORESC AB SCRN 3003748B","code_information":[{"code":"86036","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-FLUORESC AB SCRN 3003748B","code_information":[{"code":"86036","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":58.62,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"ANTINUCLEAR AB SCR","code_information":[{"code":"86038","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":139.39,"maximum":214.88,"gross_charge":263,"discounted_cash":60.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.88,"methodology":"fee schedule"}]}]},{"description":"ANTINUCLEAR AB SCR","code_information":[{"code":"86038","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.25,"maximum":214.88,"gross_charge":263,"discounted_cash":60.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANA IGG ELISA WRFLX 50080","code_information":[{"code":"86038","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":55.65,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANA IGG ELISA WRFLX 50080","code_information":[{"code":"86038","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.25,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANA IGG ELISA WRFLX 50317","code_information":[{"code":"86038","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":135.15,"maximum":208.34,"gross_charge":255,"discounted_cash":58.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANA IGG ELISA WRFLX 50317","code_information":[{"code":"86038","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.25,"maximum":208.34,"gross_charge":255,"discounted_cash":58.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANA HEP2 IGG RFLX 3000601","code_information":[{"code":"86039","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":122.43,"maximum":188.73,"gross_charge":231,"discounted_cash":52.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":122.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANA HEP2 IGG RFLX 3000601","code_information":[{"code":"86039","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.69,"maximum":188.73,"gross_charge":231,"discounted_cash":52.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":122.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANA HEP2 SUB IGG 3000082","code_information":[{"code":"86039","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":21.2,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANA HEP2 SUB IGG 3000082","code_information":[{"code":"86039","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.69,"maximum":54.32,"gross_charge":40,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTINUCLEAR AB 3000480A","code_information":[{"code":"86039","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":80.56,"maximum":124.19,"gross_charge":152,"discounted_cash":34.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTINUCLEAR AB 3000480A","code_information":[{"code":"86039","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.69,"maximum":124.19,"gross_charge":152,"discounted_cash":34.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":32.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"}]}]},{"description":"REHABILITATION","code_information":[{"code":"8604","type":"APR-DRG"}],"standard_charges":[{"minimum":15014,"maximum":15014,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15014,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15014,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15014,"methodology":"case rate"}]}]},{"description":"RL-A-ACETLYLCHOL BIND AB 80009","code_information":[{"code":"86041","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACETLYLCHOL BIND AB 80009","code_information":[{"code":"86041","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.04,"maximum":89.53,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACETYLCHOL RECEP AB 99580","code_information":[{"code":"86042","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":129.85,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACETYLCHOL RECEP AB 99580","code_information":[{"code":"86042","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.04,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACHR BLOCKING AB 2001571B","code_information":[{"code":"86042","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACHR BLOCKING AB 2001571B","code_information":[{"code":"86042","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.04,"maximum":89.53,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACHR MODULATING AB 99521","code_information":[{"code":"86043","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":129.85,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACHR MODULATING AB 99521","code_information":[{"code":"86043","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-AQUAPORIN4 REC AB 2003036","code_information":[{"code":"86051","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":129.85,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-AQUAPORIN4 REC AB 2003036","code_information":[{"code":"86051","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX AQP4 IGG IFA 2013320","code_information":[{"code":"86052","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":218.36,"maximum":336.61,"gross_charge":412,"discounted_cash":94.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":336.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX AQP4 IGG IFA 2013320","code_information":[{"code":"86052","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":336.61,"gross_charge":412,"discounted_cash":94.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":336.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-STREPTOLYSIN O AB 50095","code_information":[{"code":"86060","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":103.35,"maximum":159.32,"gross_charge":195,"discounted_cash":44.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":159.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-STREPTOLYSIN O AB 50095","code_information":[{"code":"86060","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":4.38,"maximum":159.32,"gross_charge":195,"discounted_cash":44.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":159.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"}]}]},{"description":"MEG","code_information":[{"code":"861","type":"RC"}],"standard_charges":[{"minimum":5106,"maximum":5819,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":5819,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5106,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5779,"methodology":"case rate"}]}]},{"description":"SIGNS SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"8611","type":"APR-DRG"}],"standard_charges":[{"minimum":3175,"maximum":3175,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3175,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3175,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3175,"methodology":"case rate"}]}]},{"description":"SIGNS SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"8612","type":"APR-DRG"}],"standard_charges":[{"minimum":3962,"maximum":3962,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3962,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3962,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3962,"methodology":"case rate"}]}]},{"description":"SIGNS SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"8613","type":"APR-DRG"}],"standard_charges":[{"minimum":5690,"maximum":5690,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5690,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5690,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5690,"methodology":"case rate"}]}]},{"description":"SIGNS SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"8614","type":"APR-DRG"}],"standard_charges":[{"minimum":9379,"maximum":9379,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9379,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9379,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9379,"methodology":"case rate"}]}]},{"description":"C-REACTIVE PROTEIN","code_information":[{"code":"86140","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":90.1,"maximum":138.89,"gross_charge":170,"discounted_cash":38.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.89,"methodology":"fee schedule"}]}]},{"description":"C-REACTIVE PROTEIN","code_information":[{"code":"86140","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":138.89,"gross_charge":170,"discounted_cash":38.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"C-REACTIVE PROTEIN HIGH SENS","code_information":[{"code":"86141","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":158.47,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"}]}]},{"description":"C-REACTIVE PROTEIN HIGH SENS","code_information":[{"code":"86141","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.77,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-B2 GLYCOPRO 1 IGGIGM50321","code_information":[{"code":"86146","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":27.03,"maximum":41.67,"gross_charge":51,"discounted_cash":11.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-B2 GLYCOPRO 1 IGGIGM50321","code_information":[{"code":"86146","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.27,"maximum":123.89,"gross_charge":51,"discounted_cash":11.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA2 GLYCO 1 AB 2002569","code_information":[{"code":"86146","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":21.73,"maximum":33.5,"gross_charge":41,"discounted_cash":9.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA2 GLYCO 1 AB 2002569","code_information":[{"code":"86146","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.27,"maximum":123.89,"gross_charge":41,"discounted_cash":9.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"CARDIOLIPIN AB EA IG CLASS","code_information":[{"code":"86147","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":120.84,"maximum":186.28,"gross_charge":228,"discounted_cash":52.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":186.28,"methodology":"fee schedule"}]}]},{"description":"CARDIOLIPIN AB EA IG CLASS","code_information":[{"code":"86147","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.27,"maximum":186.28,"gross_charge":228,"discounted_cash":52.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":186.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARDIO IGG IGM IGA 51162","code_information":[{"code":"86147","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":134.09,"maximum":206.71,"gross_charge":253,"discounted_cash":57.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARDIO IGG IGM IGA 51162","code_information":[{"code":"86147","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.27,"maximum":206.71,"gross_charge":253,"discounted_cash":57.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARDIOLIPIN AB IGA 98358","code_information":[{"code":"86147","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":133.56,"maximum":205.89,"gross_charge":252,"discounted_cash":57.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":133.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":205.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARDIOLIPIN AB IGA 98358","code_information":[{"code":"86147","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.27,"maximum":205.89,"gross_charge":252,"discounted_cash":57.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":133.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":205.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARDIOLIPIN IGG IGM 99344","code_information":[{"code":"86147","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.84,"maximum":22.88,"gross_charge":28,"discounted_cash":6.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARDIOLIPIN IGG IGM 99344","code_information":[{"code":"86147","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.84,"maximum":123.89,"gross_charge":28,"discounted_cash":6.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIPHOSPHAT AB 2012729A","code_information":[{"code":"86148","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":45.58,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIPHOSPHAT AB 2012729A","code_information":[{"code":"86148","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.64,"maximum":78.23,"gross_charge":86,"discounted_cash":19.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHOSP AB IGG IGM IGA50905","code_information":[{"code":"86148","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-PHOSP AB IGG IGM IGA50905","code_information":[{"code":"86148","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.64,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"}]}]},{"description":"COLD AGGLUTININ SCREEN","code_information":[{"code":"86156","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":41.34,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"}]}]},{"description":"COLD AGGLUTININ SCREEN","code_information":[{"code":"86156","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":4.84,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-COLD AGGLUTININS 50175","code_information":[{"code":"86157","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-COLD AGGLUTININS 50175","code_information":[{"code":"86157","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":4.83,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"}]}]},{"description":"COMPLEMENT AG C3","code_information":[{"code":"86160","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":143.1,"maximum":220.59,"gross_charge":270,"discounted_cash":61.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"}]}]},{"description":"COMPLEMENT AG C3","code_information":[{"code":"86160","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":220.59,"gross_charge":270,"discounted_cash":61.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"}]}]},{"description":"RL-A-C1 ESTERASE INHIBIT 50140","code_information":[{"code":"86160","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":39.22,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-C1 ESTERASE INHIBIT 50140","code_information":[{"code":"86160","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"}]}]},{"description":"RL-A-COMP COMPONENT1Q 99130","code_information":[{"code":"86160","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":261.82,"maximum":403.6,"gross_charge":494,"discounted_cash":113.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":403.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-COMP COMPONENT1Q 99130","code_information":[{"code":"86160","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":403.6,"gross_charge":494,"discounted_cash":113.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":261.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":403.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"}]}]},{"description":"RL-A-C1 ESTERASE FUNCT 50141","code_information":[{"code":"86161","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":25.44,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-C1 ESTERASE FUNCT 50141","code_information":[{"code":"86161","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":58.4,"gross_charge":48,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"}]}]},{"description":"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":15492,"maximum":38177.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34763,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34763,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21129.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15847.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15847.36,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33634.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27736.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38177.87,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15492,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15646.92,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15956.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15801.84,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15492,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15492,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15492,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15879.3,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15492,"methodology":"case rate"}]}]},{"description":"RL-A-CCP AB IGG IGA 3016632","code_information":[{"code":"86200","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-CCP AB IGG IGA 3016632","code_information":[{"code":"86200","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.77,"maximum":63.05,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"}]}]},{"description":"OTHER AFTERCARE AND CONVALESCENCE","code_information":[{"code":"8621","type":"APR-DRG"}],"standard_charges":[{"minimum":4243,"maximum":4243,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4243,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4243,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4243,"methodology":"case rate"}]}]},{"description":"RL-A-DNASE B ANTIBODY 50220","code_information":[{"code":"86215","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-DNASE B ANTIBODY 50220","code_information":[{"code":"86215","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"OTHER AFTERCARE AND CONVALESCENCE","code_information":[{"code":"8622","type":"APR-DRG"}],"standard_charges":[{"minimum":6260,"maximum":6260,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6260,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6260,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6260,"methodology":"case rate"}]}]},{"description":"RL-A-DSDNA AB IGG ELISA 50215","code_information":[{"code":"86225","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":147.87,"maximum":227.95,"gross_charge":279,"discounted_cash":63.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-DSDNA AB IGG ELISA 50215","code_information":[{"code":"86225","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.24,"maximum":227.95,"gross_charge":279,"discounted_cash":63.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"}]}]},{"description":"OTHER AFTERCARE AND CONVALESCENCE","code_information":[{"code":"8623","type":"APR-DRG"}],"standard_charges":[{"minimum":8567,"maximum":8567,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8567,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8567,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8567,"methodology":"case rate"}]}]},{"description":"RL-A-ENDOMYSIAL AB IGG 2005501","code_information":[{"code":"86231","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":20.14,"maximum":31.05,"gross_charge":38,"discounted_cash":8.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENDOMYSIAL AB IGG 2005501","code_information":[{"code":"86231","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.25,"maximum":58.83,"gross_charge":38,"discounted_cash":8.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX ENDOMYSIAL IGA 50736","code_information":[{"code":"86231","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":25.44,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX ENDOMYSIAL IGA 50736","code_information":[{"code":"86231","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.25,"maximum":58.83,"gross_charge":48,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENA AB ANY METHD 3000480B","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":323.3,"maximum":498.37,"gross_charge":610,"discounted_cash":139.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":323.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":498.37,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENA AB ANY METHD 3000480B","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.75,"maximum":498.37,"gross_charge":610,"discounted_cash":139.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":323.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":498.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-FIBRILLAR U3 IGG 2012173","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":228.43,"maximum":352.13,"gross_charge":431,"discounted_cash":98.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":228.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-FIBRILLAR U3 IGG 2012173","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.75,"maximum":352.13,"gross_charge":431,"discounted_cash":98.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":228.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-JO-1 ANTIBODY IGG 99592","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-JO-1 ANTIBODY IGG 99592","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.75,"maximum":87.24,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-PM/SCL 100 AB IGG 2003040","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":154.23,"maximum":237.75,"gross_charge":291,"discounted_cash":66.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-PM/SCL 100 AB IGG 2003040","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.75,"maximum":237.75,"gross_charge":291,"discounted_cash":66.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX SSA RO ENA 2012074","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":31.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX SSA RO ENA 2012074","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.75,"maximum":87.24,"gross_charge":59,"discounted_cash":13.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"}]}]},{"description":"OTHER AFTERCARE AND CONVALESCENCE","code_information":[{"code":"8624","type":"APR-DRG"}],"standard_charges":[{"minimum":8757,"maximum":8757,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8757,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8757,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8757,"methodology":"case rate"}]}]},{"description":"FLUORESCENT AB SCREEN","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":159.53,"maximum":245.92,"gross_charge":301,"discounted_cash":68.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"}]}]},{"description":"FLUORESCENT AB SCREEN","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":245.92,"gross_charge":301,"discounted_cash":68.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-FLUORESC AB SCRN 2008403B","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":129.85,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-FLUORESC AB SCRN 2008403B","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-NMDA IGG CSF RFLX 2005164","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":149.46,"maximum":230.4,"gross_charge":282,"discounted_cash":64.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-NMDA IGG CSF RFLX 2005164","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":230.4,"gross_charge":282,"discounted_cash":64.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX AN/PC IFA SER3018891","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":57.24,"maximum":88.24,"gross_charge":108,"discounted_cash":24.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX AN/PC IFA SER3018891","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":88.24,"gross_charge":108,"discounted_cash":24.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"FLUORESCENT AB TITER","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"FLUORESCENT AB TITER","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RF PCCA TITER CSF 2010845","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":64.66,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-RF PCCA TITER CSF 2010845","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL DSDNA IGG IFA 2002693","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.09,"maximum":43.31,"gross_charge":53,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL DSDNA IGG IFA 2002693","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":58.62,"gross_charge":53,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX ANNA IFA IGG 50892","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":49.91,"maximum":76.93,"gross_charge":94.16,"discounted_cash":21.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX ANNA IFA IGG 50892","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":76.93,"gross_charge":94.16,"discounted_cash":21.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX AQP4 S TITER 2013323","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":218.36,"maximum":336.61,"gross_charge":412,"discounted_cash":94.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":336.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX AQP4 S TITER 2013323","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":336.61,"gross_charge":412,"discounted_cash":94.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":336.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX NMDA AB IGG T2006311","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":219.95,"maximum":339.06,"gross_charge":415,"discounted_cash":95.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":219.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":339.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX NMDA AB IGG T2006311","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":339.06,"gross_charge":415,"discounted_cash":95.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":219.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":339.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX PURKIN CELL AB 59441","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":45.58,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX PURKIN CELL AB 59441","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX SM MSC IGG TIT 51244","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":39.22,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX SM MSC IGG TIT 51244","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX STM IGG TIT 2012516","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX STM IGG TIT 2012516","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":58.62,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-DGP AB IGA 51357","code_information":[{"code":"86258","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-DGP AB IGA 51357","code_information":[{"code":"86258","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":56.11,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-GLIADIN AB IGG IGA 51358","code_information":[{"code":"86258","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-GLIADIN AB IGG IGA 51358","code_information":[{"code":"86258","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":56.11,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX DGP AB IGG 51359","code_information":[{"code":"86258","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":25.44,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX DGP AB IGG 51359","code_information":[{"code":"86258","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":56.11,"gross_charge":48,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"minimum":9005.55,"maximum":20382.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18559,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18559,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15975.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11982.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11982.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17956.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14808.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20382.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9005.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9095.61,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9275.72,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9185.67,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9005.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9005.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9005.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9230.69,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9005.55,"methodology":"case rate"}]}]},{"description":"IMMUNO TUMOR AG CA 15-3 27-29","code_information":[{"code":"86300","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":160.59,"maximum":247.56,"gross_charge":303,"discounted_cash":69.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":160.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.56,"methodology":"fee schedule"}]}]},{"description":"IMMUNO TUMOR AG CA 15-3 27-29","code_information":[{"code":"86300","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":247.56,"gross_charge":303,"discounted_cash":69.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":160.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-CANCER AG 27 29 80392","code_information":[{"code":"86300","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":55.12,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-CANCER AG 27 29 80392","code_information":[{"code":"86300","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":101.27,"gross_charge":104,"discounted_cash":23.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-CANCER AG-GI 19-9 80461","code_information":[{"code":"86301","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":68.37,"maximum":105.4,"gross_charge":129,"discounted_cash":29.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-CANCER AG-GI 19-9 80461","code_information":[{"code":"86301","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":105.4,"gross_charge":129,"discounted_cash":29.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"IMMUNO TUMOR AG CA 125","code_information":[{"code":"86304","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":227.9,"maximum":351.31,"gross_charge":430,"discounted_cash":98.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":351.31,"methodology":"fee schedule"}]}]},{"description":"IMMUNO TUMOR AG CA 125","code_information":[{"code":"86304","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":351.31,"gross_charge":430,"discounted_cash":98.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":351.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-HUMAN EPIDI PROT4 2003020","code_information":[{"code":"86305","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":64.13,"maximum":98.86,"gross_charge":121,"discounted_cash":27.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-HUMAN EPIDI PROT4 2003020","code_information":[{"code":"86305","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":101.27,"gross_charge":121,"discounted_cash":27.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"MONO TEST SCRN","code_information":[{"code":"86308","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":124.02,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"}]}]},{"description":"MONO TEST SCRN","code_information":[{"code":"86308","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"NEONATAL AFTERCARE","code_information":[{"code":"8631","type":"APR-DRG"}],"standard_charges":[{"minimum":3499,"maximum":3499,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3499,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3499,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3499,"methodology":"case rate"}]}]},{"description":"RL-A-CHROMOGRANIN A SRM3002867","code_information":[{"code":"86316","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":68.37,"maximum":105.4,"gross_charge":129,"discounted_cash":29.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROMOGRANIN A SRM3002867","code_information":[{"code":"86316","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":105.4,"gross_charge":129,"discounted_cash":29.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEURON SP ENO CSF 3004314","code_information":[{"code":"86316","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEURON SP ENO CSF 3004314","code_information":[{"code":"86316","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":101.27,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEURON SP ENO SER 3004312","code_information":[{"code":"86316","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEURON SP ENO SER 3004312","code_information":[{"code":"86316","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.48,"maximum":101.27,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-DIPTH TETANUS IGG 50595","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":31.87,"gross_charge":39,"discounted_cash":8.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-DIPTH TETANUS IGG 50595","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.99,"maximum":72.93,"gross_charge":39,"discounted_cash":8.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-HAEMOPH INFLU B IGG 50542","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":52.47,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-HAEMOPH INFLU B IGG 50542","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.99,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA INFECT AB QN 3001255A","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":453.6,"maximum":699.23,"gross_charge":855.84,"discounted_cash":195.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":699.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA INFECT AB QN 3001255A","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.99,"maximum":699.23,"gross_charge":855.84,"discounted_cash":195.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":699.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-TETANUS AB IGG 50535","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-TETANUS AB IGG 50535","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.99,"maximum":72.93,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"}]}]},{"description":"NEONATAL AFTERCARE","code_information":[{"code":"8632","type":"APR-DRG"}],"standard_charges":[{"minimum":9806,"maximum":9806,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"}]}]},{"description":"RL-A-TEICHOIC ACID AB 50775","code_information":[{"code":"86329","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.55,"maximum":28.6,"gross_charge":35,"discounted_cash":8.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-TEICHOIC ACID AB 50775","code_information":[{"code":"86329","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.43,"maximum":68.35,"gross_charge":35,"discounted_cash":8.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"}]}]},{"description":"NEONATAL AFTERCARE","code_information":[{"code":"8633","type":"APR-DRG"}],"standard_charges":[{"minimum":26324,"maximum":26324,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26324,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26324,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26324,"methodology":"case rate"}]}]},{"description":"RL-A-ID GEL QL AB/AG 3001560A","code_information":[{"code":"86331","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":39.22,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-ID GEL QL AB/AG 3001560A","code_information":[{"code":"86331","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-ID GEL QL AB/AG 3001561C","code_information":[{"code":"86331","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-ID GEL QL AB/AG 3001561C","code_information":[{"code":"86331","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":58.33,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-ID GEL QL AB/AG 3006065A","code_information":[{"code":"86331","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":17.98,"gross_charge":22,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-ID GEL QL AB/AG 3006065A","code_information":[{"code":"86331","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":58.33,"gross_charge":22,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-C1Q BINDING ASSAY 50301","code_information":[{"code":"86332","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":79.5,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-C1Q BINDING ASSAY 50301","code_information":[{"code":"86332","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.62,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"}]}]},{"description":"RL-A-CIC C3 FRAG 3004431","code_information":[{"code":"86332","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":68.37,"maximum":105.4,"gross_charge":129,"discounted_cash":29.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-CIC C3 FRAG 3004431","code_information":[{"code":"86332","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.62,"maximum":118.59,"gross_charge":129,"discounted_cash":29.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"}]}]},{"description":"RL-A-CIRC IMM COMP PNL 3004430","code_information":[{"code":"86332","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":51.94,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-CIRC IMM COMP PNL 3004430","code_information":[{"code":"86332","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.62,"maximum":118.59,"gross_charge":98,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFIX ELECTRO SERUM","code_information":[{"code":"86334","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":444.14,"maximum":684.65,"gross_charge":838,"discounted_cash":191.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":444.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":684.65,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFIX ELECTRO SERUM","code_information":[{"code":"86334","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.4,"maximum":684.65,"gross_charge":838,"discounted_cash":191.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":444.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":684.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-IFE QUAL GEL 2012572","code_information":[{"code":"86334","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":47.17,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-IFE QUAL GEL 2012572","code_information":[{"code":"86334","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.4,"maximum":108.71,"gross_charge":89,"discounted_cash":20.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-IFE SERUM 51225C","code_information":[{"code":"86334","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-IFE SERUM 51225C","code_information":[{"code":"86334","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.4,"maximum":108.71,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":23.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFIXATION ELECTR OTHR FLD","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":140.98,"maximum":217.33,"gross_charge":266,"discounted_cash":60.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.33,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFIXATION ELECTR OTHR FLD","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":17.61,"maximum":217.33,"gross_charge":266,"discounted_cash":60.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA 2 TRANSFERRIN 50047","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":179.14,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA 2 TRANSFERRIN 50047","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":17.61,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOF ELECTROPH3002104B","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":29.15,"maximum":44.94,"gross_charge":55,"discounted_cash":12.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMMUNOF ELECTROPH3002104B","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":17.61,"maximum":142.85,"gross_charge":55,"discounted_cash":12.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-INHIBIN A DIMER 70137","code_information":[{"code":"86336","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-INHIBIN A DIMER 70137","code_information":[{"code":"86336","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.35,"maximum":75.86,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-INSULIN ANTIBODY 99228","code_information":[{"code":"86337","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":70.49,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-INSULIN ANTIBODY 99228","code_information":[{"code":"86337","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.84,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":62.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"}]}]},{"description":"NEONATAL AFTERCARE","code_information":[{"code":"8634","type":"APR-DRG"}],"standard_charges":[{"minimum":68552,"maximum":68552,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":68552,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":68552,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":68552,"methodology":"case rate"}]}]},{"description":"RL-A-INTRINSIC FACTOR AB 70210","code_information":[{"code":"86340","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":49.29,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-INTRINSIC FACTOR AB 70210","code_information":[{"code":"86340","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.04,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"}]}]},{"description":"ISLET CELL ANTIBODY","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":128.26,"maximum":197.72,"gross_charge":242,"discounted_cash":55.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197.72,"methodology":"fee schedule"}]}]},{"description":"ISLET CELL ANTIBODY","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.14,"maximum":197.72,"gross_charge":242,"discounted_cash":55.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAD AB CSF 3002788","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":49.82,"maximum":76.8,"gross_charge":94,"discounted_cash":21.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAD AB CSF 3002788","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.14,"maximum":114.73,"gross_charge":94,"discounted_cash":21.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAD ANTIBODY 2001771","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-GAD ANTIBODY 2001771","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.14,"maximum":114.73,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA-2 AUTOANTIBODY 3001499","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":139.39,"maximum":214.88,"gross_charge":263,"discounted_cash":60.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA-2 AUTOANTIBODY 3001499","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.14,"maximum":214.88,"gross_charge":263,"discounted_cash":60.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-ISLET CYTOPL AB IGG 50138","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":65.19,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-ISLET CYTOPL AB IGG 50138","code_information":[{"code":"86341","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.14,"maximum":114.73,"gross_charge":123,"discounted_cash":28.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"}]}]},{"description":"CELL FUNCT ASSAY W STIM/DETECT","code_information":[{"code":"86352","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":458.45,"maximum":706.71,"gross_charge":865,"discounted_cash":198.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":458.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":706.71,"methodology":"fee schedule"}]}]},{"description":"CELL FUNCT ASSAY W STIM/DETECT","code_information":[{"code":"86352","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":81.51,"maximum":706.71,"gross_charge":865,"discounted_cash":198.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":661.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":661.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":281.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":281.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":397.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":458.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":706.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":137.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":139.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":138.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEUTROPHI OXID BURST96657","code_information":[{"code":"86352","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":259.17,"maximum":399.52,"gross_charge":489,"discounted_cash":111.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":259.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":399.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-NEUTROPHI OXID BURST96657","code_information":[{"code":"86352","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":81.51,"maximum":661.16,"gross_charge":489,"discounted_cash":111.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":661.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":661.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":281.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":281.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":397.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":259.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":399.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":137.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":139.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":138.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-URTICARIA IND ACTV2005413","code_information":[{"code":"86352","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":287.79,"maximum":443.64,"gross_charge":543,"discounted_cash":124.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-URTICARIA IND ACTV2005413","code_information":[{"code":"86352","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":81.51,"maximum":661.16,"gross_charge":543,"discounted_cash":124.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":661.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":661.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":281.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":281.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":397.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":137.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":139.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":138.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-B CELLS TOT COUNT 95862A","code_information":[{"code":"86355","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":67.84,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-B CELLS TOT COUNT 95862A","code_information":[{"code":"86355","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":22.63,"maximum":183.65,"gross_charge":128,"discounted_cash":29.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-B CELLS TOT COUNT 95892A","code_information":[{"code":"86355","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":115.54,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-B CELLS TOT COUNT 95892A","code_information":[{"code":"86355","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":22.63,"maximum":183.65,"gross_charge":218,"discounted_cash":49.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-LYMPH SUBSET P4 BAL 93420","code_information":[{"code":"86356","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":66.25,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-LYMPH SUBSET P4 BAL 93420","code_information":[{"code":"86356","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":16.06,"maximum":130.33,"gross_charge":125,"discounted_cash":28.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-LYMPHO TRANSPL CD3 95949","code_information":[{"code":"86356","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":62.01,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-LYMPHO TRANSPL CD3 95949","code_information":[{"code":"86356","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":16.06,"maximum":130.33,"gross_charge":117,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-MONONUC CELL AG 95862E","code_information":[{"code":"86356","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-MONONUC CELL AG 95862E","code_information":[{"code":"86356","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":16.06,"maximum":130.33,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-PNH RBC HIGH SENS 2004366","code_information":[{"code":"86356","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":65.72,"maximum":101.31,"gross_charge":124,"discounted_cash":28.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-PNH RBC HIGH SENS 2004366","code_information":[{"code":"86356","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":16.06,"maximum":130.33,"gross_charge":124,"discounted_cash":28.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-NK CELLS TOT COUNT 95862B","code_information":[{"code":"86357","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":67.84,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-NK CELLS TOT COUNT 95862B","code_information":[{"code":"86357","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":22.63,"maximum":183.65,"gross_charge":128,"discounted_cash":29.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-NK CELLS TOT COUNT 95892B","code_information":[{"code":"86357","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":115.54,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-NK CELLS TOT COUNT 95892B","code_information":[{"code":"86357","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":22.63,"maximum":183.65,"gross_charge":218,"discounted_cash":49.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELLS TOT COUNT 95853A","code_information":[{"code":"86359","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELLS TOT COUNT 95853A","code_information":[{"code":"86359","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":22.63,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELLS TOT COUNT 95862C","code_information":[{"code":"86359","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELLS TOT COUNT 95862C","code_information":[{"code":"86359","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":22.63,"maximum":183.65,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELLS TOT COUNT 95892C","code_information":[{"code":"86359","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":115.54,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELLS TOT COUNT 95892C","code_information":[{"code":"86359","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":22.63,"maximum":183.65,"gross_charge":218,"discounted_cash":49.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELL ABS CD4 CD8 95853B","code_information":[{"code":"86360","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":145.22,"maximum":223.86,"gross_charge":274,"discounted_cash":62.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELL ABS CD4 CD8 95853B","code_information":[{"code":"86360","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.18,"maximum":228.67,"gross_charge":274,"discounted_cash":62.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":97.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":97.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":137.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":48.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELL ABS CD4 CD8 95862D","code_information":[{"code":"86360","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELL ABS CD4 CD8 95862D","code_information":[{"code":"86360","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.18,"maximum":228.67,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":97.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":97.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":137.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":48.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELL ABS CD4 CD8 95892D","code_information":[{"code":"86360","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":144.16,"maximum":222.23,"gross_charge":272,"discounted_cash":62.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-T CELL ABS CD4 CD8 95892D","code_information":[{"code":"86360","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.18,"maximum":228.67,"gross_charge":272,"discounted_cash":62.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":97.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":97.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":137.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":48.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX TTG AB IGG 56009","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":29.15,"maximum":44.94,"gross_charge":55,"discounted_cash":12.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX TTG AB IGG 56009","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":56.11,"gross_charge":55,"discounted_cash":12.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-TTG AB IGA RF ENDM3016861","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":38.4,"gross_charge":47,"discounted_cash":10.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-TTG AB IGA RF ENDM3016861","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":56.11,"gross_charge":47,"discounted_cash":10.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-TTG AB IGA W RFLX 50734","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":129.85,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-TTG AB IGA W RFLX 50734","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-TTG ANTIBODY IGA 97709","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-TTG ANTIBODY IGA 97709","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":56.11,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-TTG ANTIBODY IGG 56009","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-TTG ANTIBODY IGG 56009","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-MUSK IGG CBAIFA SR3006198","code_information":[{"code":"86366","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":625.4,"maximum":964.06,"gross_charge":1180,"discounted_cash":270.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":625.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":964.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-MUSK IGG CBAIFA SR3006198","code_information":[{"code":"86366","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.04,"maximum":964.06,"gross_charge":1180,"discounted_cash":270.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":625.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":964.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.04,"methodology":"fee schedule"}]}]},{"description":"MICROSOMAL ANTIBODY","code_information":[{"code":"86376","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":102.29,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"}]}]},{"description":"MICROSOMAL ANTIBODY","code_information":[{"code":"86376","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.73,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-LIVER-KIDNEY MIC IGG99270","code_information":[{"code":"86376","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"}]}]},{"description":"RL-A-LIVER-KIDNEY MIC IGG99270","code_information":[{"code":"86376","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.73,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-MICROSOMAL AB 50645A","code_information":[{"code":"86376","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":30.74,"maximum":47.39,"gross_charge":58,"discounted_cash":13.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-MICROSOMAL AB 50645A","code_information":[{"code":"86376","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.73,"maximum":70.78,"gross_charge":58,"discounted_cash":13.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-MITOCHONDRIAL M2 AB 50065","code_information":[{"code":"86381","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-MITOCHONDRIAL M2 AB 50065","code_information":[{"code":"86381","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.27,"maximum":123.89,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.27,"methodology":"fee schedule"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"minimum":8217.55,"maximum":18101.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15918,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15918,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18101.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13576.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13576.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15401.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12700.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17481.86,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8217.55,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8299.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8464.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8381.91,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8217.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8217.55,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8217.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8422.99,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8217.55,"methodology":"case rate"}]}]},{"description":"PARTICLE AGG SCREEN EA AB","code_information":[{"code":"86403","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":82.68,"maximum":127.46,"gross_charge":156,"discounted_cash":35.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.46,"methodology":"fee schedule"}]}]},{"description":"PARTICLE AGG SCREEN EA AB","code_information":[{"code":"86403","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.92,"maximum":127.46,"gross_charge":156,"discounted_cash":35.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID FACTOR QUALITATIVE","code_information":[{"code":"86430","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID FACTOR QUALITATIVE","code_information":[{"code":"86430","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":3.68,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-QFT GOLD PL 1TUBE 3017554","code_information":[{"code":"86480","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":135.15,"maximum":208.34,"gross_charge":255,"discounted_cash":58.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-QFT GOLD PL 1TUBE 3017554","code_information":[{"code":"86480","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":37.18,"maximum":301.67,"gross_charge":255,"discounted_cash":58.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":301.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":301.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":222.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":167.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":167.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":62.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":63.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-QFT GOLD PL 4TUBE 3000399","code_information":[{"code":"86480","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":65.72,"maximum":101.31,"gross_charge":124,"discounted_cash":28.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-QFT GOLD PL 4TUBE 3000399","code_information":[{"code":"86480","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":37.18,"maximum":301.67,"gross_charge":124,"discounted_cash":28.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":301.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":301.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":222.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":167.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":167.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":62.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":63.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"}]}]},{"description":"VIRAL ILLNESS WITH MCC","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"minimum":8740.06,"maximum":28743.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26173,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26173,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11653.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8740.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8740.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":25323.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20882.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28743.77,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12686.46,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12813.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13067.06,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12940.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12686.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12686.46,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12686.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13003.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12686.46,"methodology":"case rate"}]}]},{"description":"RL-A-PNEUMO AB IGG 23 2005779","code_information":[{"code":"86581","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":39.75,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-PNEUMO AB IGG 23 2005779","code_information":[{"code":"86581","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.13,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-STREPTO PNEUMON IGG 50725","code_information":[{"code":"86581","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":49.29,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-STREPTO PNEUMON IGG 50725","code_information":[{"code":"86581","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.13,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-VDRL CSF W REFLEX 50206","code_information":[{"code":"86592","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-VDRL CSF W REFLEX 50206","code_information":[{"code":"86592","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":2.56,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"SYPHILIS VDRL RPR QL","code_information":[{"code":"86592","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":67.31,"maximum":103.76,"gross_charge":127,"discounted_cash":29.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"}]}]},{"description":"SYPHILIS VDRL RPR QL","code_information":[{"code":"86592","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":2.56,"maximum":103.76,"gross_charge":127,"discounted_cash":29.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX VDRL CSF TIT 2012513","code_information":[{"code":"86593","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":57.24,"maximum":88.24,"gross_charge":108,"discounted_cash":24.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX VDRL CSF TIT 2012513","code_information":[{"code":"86593","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":2.64,"maximum":88.24,"gross_charge":108,"discounted_cash":24.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"}]}]},{"description":"SYPHILIS VDRL RPR QUANTITATIVE","code_information":[{"code":"86593","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"SYPHILIS VDRL RPR QUANTITATIVE","code_information":[{"code":"86593","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":2.64,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"}]}]},{"description":"AB VG CALCIUM CHNL EA","code_information":[{"code":"86596","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":164.83,"maximum":254.09,"gross_charge":311,"discounted_cash":71.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":164.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.09,"methodology":"fee schedule"}]}]},{"description":"AB VG CALCIUM CHNL EA","code_information":[{"code":"86596","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":254.09,"gross_charge":311,"discounted_cash":71.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":164.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-VGCC ANTIBODY 92628","code_information":[{"code":"86596","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":315.88,"maximum":486.94,"gross_charge":596,"discounted_cash":136.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":315.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":486.94,"methodology":"fee schedule"}]}]},{"description":"RL-A-VGCC ANTIBODY 92628","code_information":[{"code":"86596","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":486.94,"gross_charge":596,"discounted_cash":136.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":315.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":486.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"VIRAL ILLNESS WITHOUT MCC","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"minimum":8115.47,"maximum":35101.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15379,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15379,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35101.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26326.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26326.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14879.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12270.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16889.78,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8115.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8196.63,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8358.94,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8277.78,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8115.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8115.47,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8115.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8318.36,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8115.47,"methodology":"case rate"}]}]},{"description":"RL-A ASPER ABS IMMDIFF 50171","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":49.29,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"}]}]},{"description":"RL-A ASPER ABS IMMDIFF 50171","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":75.99,"gross_charge":93,"discounted_cash":21.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILLUS AB 3000235A","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILLUS AB 3000235A","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":73.22,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILLUS AB 3001560B","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":39.22,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILLUS AB 3001560B","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":73.22,"gross_charge":74,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILLUS AB 3006065B","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":17.98,"gross_charge":22,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILLUS AB 3006065B","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":73.22,"gross_charge":22,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILLUS AB CF 50100","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILLUS AB CF 50100","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":73.22,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILUS AB CF ID 50101","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":145.22,"maximum":223.86,"gross_charge":274,"discounted_cash":62.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERGILUS AB CF ID 50101","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":223.86,"gross_charge":274,"discounted_cash":62.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-B HENSELAE IGG IGM 50108","code_information":[{"code":"86611","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":186.03,"maximum":286.77,"gross_charge":351,"discounted_cash":80.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":186.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":286.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-B HENSELAE IGG IGM 50108","code_information":[{"code":"86611","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.1,"maximum":286.77,"gross_charge":351,"discounted_cash":80.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":186.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":286.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-B QUINTANA IGG IGM 50106","code_information":[{"code":"86611","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-B QUINTANA IGG IGM 50106","code_information":[{"code":"86611","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.1,"maximum":49.53,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB BLASTOMYCES 3000235B","code_information":[{"code":"86612","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB BLASTOMYCES 3000235B","code_information":[{"code":"86612","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.74,"maximum":62.77,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-BLASTO EIA SRMRFLX3000236","code_information":[{"code":"86612","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":136.21,"maximum":209.97,"gross_charge":257,"discounted_cash":58.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-BLASTO EIA SRMRFLX3000236","code_information":[{"code":"86612","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.74,"maximum":209.97,"gross_charge":257,"discounted_cash":58.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BLASTO AB ID 50172","code_information":[{"code":"86612","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":27.56,"maximum":42.49,"gross_charge":52,"discounted_cash":11.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BLASTO AB ID 50172","code_information":[{"code":"86612","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.74,"maximum":62.77,"gross_charge":52,"discounted_cash":11.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORD IGG IGM RFLX 2001784","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORD IGG IGM RFLX 2001784","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORDETELLA IGA IGG2001774","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORDETELLA IGA IGG2001774","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORDETELLA PANEL3 2001775","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":162.18,"maximum":250.01,"gross_charge":306,"discounted_cash":70.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":162.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORDETELLA PANEL3 2001775","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":250.01,"gross_charge":306,"discounted_cash":70.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":162.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BORDA BLOT 2004316","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BORDA BLOT 2004316","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BORDG BLOT 2004327","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BORDG BLOT 2004327","code_information":[{"code":"86615","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORREL IGG IGM CSF 55260","code_information":[{"code":"86617","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":35.51,"maximum":54.74,"gross_charge":67,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORREL IGG IGM CSF 55260","code_information":[{"code":"86617","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.29,"maximum":75.36,"gross_charge":67,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORRELIA IGG IGM IB 50254","code_information":[{"code":"86617","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":51.41,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORRELIA IGG IGM IB 50254","code_information":[{"code":"86617","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.29,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"}]}]},{"description":"RL-A-B BURG E1/C10 ABS 3006053","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":102.82,"maximum":158.5,"gross_charge":194,"discounted_cash":44.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.5,"methodology":"fee schedule"}]}]},{"description":"RL-A-B BURG E1/C10 ABS 3006053","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.21,"maximum":158.5,"gross_charge":194,"discounted_cash":44.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORR BUR CSF TOT 3016760","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":37.1,"maximum":57.19,"gross_charge":70,"discounted_cash":16.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORR BUR CSF TOT 3016760","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.21,"maximum":82.88,"gross_charge":70,"discounted_cash":16.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORRELI BURG TTL CSF99483","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":332.84,"maximum":513.08,"gross_charge":628,"discounted_cash":143.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":332.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":513.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORRELI BURG TTL CSF99483","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.21,"maximum":513.08,"gross_charge":628,"discounted_cash":143.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":332.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":513.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORRELIA BURG TOTAL 50267","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORRELIA BURG TOTAL 50267","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.21,"maximum":82.88,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFXLYMEMOD2TR2NDTR3006188","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":109.18,"maximum":168.31,"gross_charge":206,"discounted_cash":47.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":168.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFXLYMEMOD2TR2NDTR3006188","code_information":[{"code":"86618","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.21,"maximum":168.31,"gross_charge":206,"discounted_cash":47.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":168.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB BRUCELLA 2010805A","code_information":[{"code":"86622","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB BRUCELLA 2010805A","code_information":[{"code":"86622","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":5.35,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-CANDIDA IGA IGG IGM 95200","code_information":[{"code":"86628","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-CANDIDA IGA IGG IGM 95200","code_information":[{"code":"86628","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":58.47,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY CHLAMYDIA 65100A","code_information":[{"code":"86631","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY CHLAMYDIA 65100A","code_information":[{"code":"86631","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.09,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":34.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHLAMYD PAN IGG IFA 65139","code_information":[{"code":"86631","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":16.43,"maximum":25.33,"gross_charge":31,"discounted_cash":7.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHLAMYD PAN IGG IFA 65139","code_information":[{"code":"86631","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.09,"maximum":57.54,"gross_charge":31,"discounted_cash":7.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":34.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB CHLAMYDIA IGM 65100B","code_information":[{"code":"86632","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":17.49,"maximum":26.97,"gross_charge":33,"discounted_cash":7.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB CHLAMYDIA IGM 65100B","code_information":[{"code":"86632","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.6,"maximum":61.69,"gross_charge":33,"discounted_cash":7.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY COCCIDIOIDES","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":96.99,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY COCCIDIOIDES","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.88,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY COCCIDIOIDES IGG","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":27.56,"maximum":42.49,"gross_charge":52,"discounted_cash":11.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY COCCIDIOIDES IGG","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.88,"maximum":55.82,"gross_charge":52,"discounted_cash":11.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCI CF ID CSF 3000061","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":107.59,"maximum":165.86,"gross_charge":203,"discounted_cash":46.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.86,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCI CF ID CSF 3000061","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.88,"maximum":165.86,"gross_charge":203,"discounted_cash":46.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCID AB CF CSF 3000059","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":67.84,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCID AB CF CSF 3000059","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.88,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCID CF ID SRM 3002995","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":94.34,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCID CF ID SRM 3002995","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.88,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCIDIOIDES AB CF 50170","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":41.87,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCIDIOIDES AB CF 50170","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.88,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"RL-A-Q FEVER IGG I II 2012625","code_information":[{"code":"86638","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":102.29,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-Q FEVER IGG I II 2012625","code_information":[{"code":"86638","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.27,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-RF QFEV IGG1 TIT 2012630","code_information":[{"code":"86638","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":47.7,"maximum":73.53,"gross_charge":90,"discounted_cash":20.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-RF QFEV IGG1 TIT 2012630","code_information":[{"code":"86638","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.27,"maximum":73.53,"gross_charge":90,"discounted_cash":20.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY CMV 50772A","code_information":[{"code":"86644","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":107.06,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY CMV 50772A","code_information":[{"code":"86644","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEGALOVIRUS IGG 50165","code_information":[{"code":"86644","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":151.05,"maximum":232.85,"gross_charge":285,"discounted_cash":65.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEGALOVIRUS IGG 50165","code_information":[{"code":"86644","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":232.85,"gross_charge":285,"discounted_cash":65.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEGALOVIRUS IGM 50553","code_information":[{"code":"86645","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":152.64,"maximum":235.3,"gross_charge":288,"discounted_cash":65.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":152.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEGALOVIRUS IGM 50553","code_information":[{"code":"86645","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":235.3,"gross_charge":288,"discounted_cash":65.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":152.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB ENCEPH CALIF 2001592A","code_information":[{"code":"86651","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB ENCEPH CALIF 2001592A","code_information":[{"code":"86651","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB ENCEPH CALIF 2001593A","code_information":[{"code":"86651","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.02,"maximum":27.78,"gross_charge":34,"discounted_cash":7.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB ENCEPH CALIF 2001593A","code_information":[{"code":"86651","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":34,"discounted_cash":7.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB ENCEPH CALIF 2001594A","code_information":[{"code":"86651","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB ENCEPH CALIF 2001594A","code_information":[{"code":"86651","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB ENCEPH CALIF 2001597A","code_information":[{"code":"86651","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":38.4,"gross_charge":47,"discounted_cash":10.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB ENCEPH CALIF 2001597A","code_information":[{"code":"86651","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":47,"discounted_cash":10.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH E EQUINE 2001592B","code_information":[{"code":"86652","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH E EQUINE 2001592B","code_information":[{"code":"86652","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH E EQUINE 2001593B","code_information":[{"code":"86652","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.02,"maximum":27.78,"gross_charge":34,"discounted_cash":7.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH E EQUINE 2001593B","code_information":[{"code":"86652","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":34,"discounted_cash":7.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH E EQUINE 2001594B","code_information":[{"code":"86652","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH E EQUINE 2001594B","code_information":[{"code":"86652","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH E EQUINE 2001597B","code_information":[{"code":"86652","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":38.4,"gross_charge":47,"discounted_cash":10.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH E EQUINE 2001597B","code_information":[{"code":"86652","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":47,"discounted_cash":10.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH ST LOUIS 2001592C","code_information":[{"code":"86653","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH ST LOUIS 2001592C","code_information":[{"code":"86653","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH ST LOUIS 2001593C","code_information":[{"code":"86653","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.02,"maximum":27.78,"gross_charge":34,"discounted_cash":7.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH ST LOUIS 2001593C","code_information":[{"code":"86653","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":34,"discounted_cash":7.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH ST LOUIS 2001594E","code_information":[{"code":"86653","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH ST LOUIS 2001594E","code_information":[{"code":"86653","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH ST LOUIS 2001597C","code_information":[{"code":"86653","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":38.4,"gross_charge":47,"discounted_cash":10.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH ST LOUIS 2001597C","code_information":[{"code":"86653","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":47,"discounted_cash":10.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH W EQUINE 2001592D","code_information":[{"code":"86654","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH W EQUINE 2001592D","code_information":[{"code":"86654","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH W EQUINE 2001593D","code_information":[{"code":"86654","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.02,"maximum":27.78,"gross_charge":34,"discounted_cash":7.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH W EQUINE 2001593D","code_information":[{"code":"86654","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":34,"discounted_cash":7.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH W EQUINE 2001594F","code_information":[{"code":"86654","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH W EQUINE 2001594F","code_information":[{"code":"86654","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH W EQUINE 2001597D","code_information":[{"code":"86654","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":38.4,"gross_charge":47,"discounted_cash":10.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENCEPH W EQUINE 2001597D","code_information":[{"code":"86654","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":64.2,"gross_charge":47,"discounted_cash":10.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-COXSACKIE B VIR AB 60055","code_information":[{"code":"86658","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":31.87,"gross_charge":39,"discounted_cash":8.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-COXSACKIE B VIR AB 60055","code_information":[{"code":"86658","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.81,"maximum":63.41,"gross_charge":39,"discounted_cash":8.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-ECHOVIRUS AB 60053","code_information":[{"code":"86658","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-ECHOVIRUS AB 60053","code_information":[{"code":"86658","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.81,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB EBV EARLY AG 50600A","code_information":[{"code":"86663","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB EBV EARLY AG 50600A","code_information":[{"code":"86663","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.87,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB EBV NUCLEAR AG 50600B","code_information":[{"code":"86664","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":50.35,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB EBV NUCLEAR AG 50600B","code_information":[{"code":"86664","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.17,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB EBV VIR CAPSID 50600C","code_information":[{"code":"86665","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":59.36,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB EBV VIR CAPSID 50600C","code_information":[{"code":"86665","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.88,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-EHRLICHIA AB IFA 51002","code_information":[{"code":"86666","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-EHRLICHIA AB IFA 51002","code_information":[{"code":"86666","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.1,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB FUNGUS NES 3003748A","code_information":[{"code":"86671","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":40.81,"maximum":62.91,"gross_charge":77,"discounted_cash":17.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB FUNGUS NES 3003748A","code_information":[{"code":"86671","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.35,"maximum":62.91,"gross_charge":77,"discounted_cash":17.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-SACC CEREVIS IGG IGA50564","code_information":[{"code":"86671","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-SACC CEREVIS IGG IGA50564","code_information":[{"code":"86671","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.35,"maximum":59.62,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-GIARDIA LAMBL PNL 2009410","code_information":[{"code":"86674","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":174.9,"maximum":269.61,"gross_charge":330,"discounted_cash":75.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-GIARDIA LAMBL PNL 2009410","code_information":[{"code":"86674","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.83,"maximum":269.61,"gross_charge":330,"discounted_cash":75.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYSTICERCOS IGG CSF 55285","code_information":[{"code":"86682","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYSTICERCOS IGG CSF 55285","code_information":[{"code":"86682","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.8,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYSTICERCOSIS IGG 55284","code_information":[{"code":"86682","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.55,"maximum":28.6,"gross_charge":35,"discounted_cash":8.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYSTICERCOSIS IGG 55284","code_information":[{"code":"86682","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.8,"maximum":63.34,"gross_charge":35,"discounted_cash":8.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-STRONGYLOIDES IGG 99564","code_information":[{"code":"86682","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-STRONGYLOIDES IGG 99564","code_information":[{"code":"86682","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.8,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL HTLV I II WBLOT 20642","code_information":[{"code":"86689","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":118.19,"maximum":182.2,"gross_charge":223,"discounted_cash":51.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":182.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL HTLV I II WBLOT 20642","code_information":[{"code":"86689","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.61,"maximum":182.2,"gross_charge":223,"discounted_cash":51.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":182.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-HDV IGM AB EIA 98507","code_information":[{"code":"86692","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":112.89,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-HDV IGM AB EIA 98507","code_information":[{"code":"86692","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.29,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS DELTA AB 20799","code_information":[{"code":"86692","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":56.18,"maximum":86.61,"gross_charge":106,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS DELTA AB 20799","code_information":[{"code":"86692","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.29,"maximum":86.61,"gross_charge":106,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB HERPES SIMP NS3017752A","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB HERPES SIMP NS3017752A","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB HERPES SIMP NSP 50772D","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":38.69,"maximum":59.65,"gross_charge":73,"discounted_cash":16.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB HERPES SIMP NSP 50772D","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":73,"discounted_cash":16.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV 1 2 IGG CSF 50394","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":182.32,"maximum":281.05,"gross_charge":344,"discounted_cash":78.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":182.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV 1 2 IGG CSF 50394","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":281.05,"gross_charge":344,"discounted_cash":78.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":182.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV TYPE 1 2 AB IGG 50293","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":20.14,"maximum":31.05,"gross_charge":38,"discounted_cash":8.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV TYPE 1 2 AB IGG 50293","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":38,"discounted_cash":8.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV1 2 IGG CSF3017747","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":30.51,"maximum":47.03,"gross_charge":57.56,"discounted_cash":13.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV1 2 IGG CSF3017747","code_information":[{"code":"86694","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":57.56,"discounted_cash":13.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV 1 GLYCO G IGG 50292","code_information":[{"code":"86695","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":84.27,"maximum":129.91,"gross_charge":159,"discounted_cash":36.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV 1 GLYCO G IGG 50292","code_information":[{"code":"86695","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":129.91,"gross_charge":159,"discounted_cash":36.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV 2 GLYCO G IGG 50294","code_information":[{"code":"86696","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.99,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV 2 GLYCO G IGG 50294","code_information":[{"code":"86696","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.61,"maximum":94.19,"gross_charge":83,"discounted_cash":19.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB HISTOPLASMA 3000235D","code_information":[{"code":"86698","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":40.81,"maximum":62.91,"gross_charge":77,"discounted_cash":17.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB HISTOPLASMA 3000235D","code_information":[{"code":"86698","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.27,"maximum":67.13,"gross_charge":77,"discounted_cash":17.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTOPLASMA CF ID 50627","code_information":[{"code":"86698","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTOPLASMA CF ID 50627","code_information":[{"code":"86698","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.27,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"minimum":17855.21,"maximum":45080.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41048,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24375.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18282.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18282.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":39716.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":32751.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45080.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17855.21,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18033.77,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18390.87,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18212.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17855.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17855.21,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17855.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18301.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17855.21,"methodology":"case rate"}]}]},{"description":"ANTIBODY HIV-1","code_information":[{"code":"86701","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":125.61,"maximum":193.63,"gross_charge":237,"discounted_cash":54.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.63,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY HIV-1","code_information":[{"code":"86701","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":5.33,"maximum":193.63,"gross_charge":237,"discounted_cash":54.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY HIV-1 2012669A","code_information":[{"code":"86701","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":116.07,"maximum":178.93,"gross_charge":219,"discounted_cash":50.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":116.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY HIV-1 2012669A","code_information":[{"code":"86701","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":5.33,"maximum":178.93,"gross_charge":219,"discounted_cash":50.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":116.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY HIV-2 2012669B","code_information":[{"code":"86702","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":116.07,"maximum":178.93,"gross_charge":219,"discounted_cash":50.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":116.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY HIV-2 2012669B","code_information":[{"code":"86702","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.11,"maximum":178.93,"gross_charge":219,"discounted_cash":50.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":116.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"}]}]},{"description":"AB HIV 1 HIV 2 SINGLE RESULT","code_information":[{"code":"86703","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"AB HIV 1 HIV 2 SINGLE RESULT","code_information":[{"code":"86703","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.22,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS B CORE AB 20091","code_information":[{"code":"86704","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":16.43,"maximum":25.33,"gross_charge":31,"discounted_cash":7.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS B CORE AB 20091","code_information":[{"code":"86704","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.23,"maximum":58.62,"gross_charge":31,"discounted_cash":7.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B CORE AB IGM","code_information":[{"code":"86705","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B CORE AB IGM","code_information":[{"code":"86705","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.06,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":34.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B SURFACE AB","code_information":[{"code":"86706","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":117.66,"maximum":181.38,"gross_charge":222,"discounted_cash":50.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.38,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B SURFACE AB","code_information":[{"code":"86706","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.44,"maximum":181.38,"gross_charge":222,"discounted_cash":50.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS BE AB 20095","code_information":[{"code":"86707","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS BE AB 20095","code_information":[{"code":"86707","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.94,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS A AB 20597A","code_information":[{"code":"86708","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS A AB 20597A","code_information":[{"code":"86708","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.43,"maximum":60.33,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS A AB (HAAB) IGM","code_information":[{"code":"86709","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":140.98,"maximum":217.33,"gross_charge":266,"discounted_cash":60.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.33,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS A AB (HAAB) IGM","code_information":[{"code":"86709","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.75,"maximum":217.33,"gross_charge":266,"discounted_cash":60.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS A AB IGM 20597B","code_information":[{"code":"86709","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS A AB IGM 20597B","code_information":[{"code":"86709","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.75,"maximum":54.82,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-INFLUENZA A AB IGG 51074","code_information":[{"code":"86710","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-INFLUENZA A AB IGG 51074","code_information":[{"code":"86710","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.13,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEPTOS IGM DOT BLOT 55233","code_information":[{"code":"86720","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":122.43,"maximum":188.73,"gross_charge":231,"discounted_cash":52.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":122.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEPTOS IGM DOT BLOT 55233","code_information":[{"code":"86720","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.72,"maximum":188.73,"gross_charge":231,"discounted_cash":52.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":122.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY MUMPS","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":64.66,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY MUMPS","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.83,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY MUMPS 3017752B","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":66.78,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY MUMPS 3017752B","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.83,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-MUMPS VIRUS AB IGG 50390","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.6,"maximum":16.34,"gross_charge":20,"discounted_cash":4.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-MUMPS VIRUS AB IGG 50390","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.83,"maximum":63.48,"gross_charge":20,"discounted_cash":4.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-MUMPS VIRUS AB IGM 99589","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":117.66,"maximum":181.38,"gross_charge":222,"discounted_cash":50.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-MUMPS VIRUS AB IGM 99589","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.83,"maximum":181.38,"gross_charge":222,"discounted_cash":50.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOPLASMA IGG IGM 50399","code_information":[{"code":"86738","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOPLASMA IGG IGM 50399","code_information":[{"code":"86738","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.94,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOPLASMA PNEUM IGG50397","code_information":[{"code":"86738","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":80.14,"maximum":123.54,"gross_charge":151.2,"discounted_cash":34.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.54,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOPLASMA PNEUM IGG50397","code_information":[{"code":"86738","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.94,"maximum":123.54,"gross_charge":151.2,"discounted_cash":34.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"RL-A PARVO B19 IGG IGM 65120","code_information":[{"code":"86747","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":176.49,"maximum":272.07,"gross_charge":333,"discounted_cash":76.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":176.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.07,"methodology":"fee schedule"}]}]},{"description":"RL-A PARVO B19 IGG IGM 65120","code_information":[{"code":"86747","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.01,"maximum":272.07,"gross_charge":333,"discounted_cash":76.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":176.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMEBIASIS AB IGG 50070","code_information":[{"code":"86753","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":96.99,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMEBIASIS AB IGG 50070","code_information":[{"code":"86753","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.43,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRYPANOSO CRUZI IGG 51076","code_information":[{"code":"86753","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":22.26,"maximum":34.32,"gross_charge":42,"discounted_cash":9.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRYPANOSO CRUZI IGG 51076","code_information":[{"code":"86753","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.43,"maximum":60.33,"gross_charge":42,"discounted_cash":9.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB RICKETTSIA 2010805B","code_information":[{"code":"86757","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":63.07,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB RICKETTSIA 2010805B","code_information":[{"code":"86757","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.61,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-RMSF AB IGG IGM IFA 50371","code_information":[{"code":"86757","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":213.06,"maximum":328.44,"gross_charge":402,"discounted_cash":92.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":213.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":328.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-RMSF AB IGG IGM IFA 50371","code_information":[{"code":"86757","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.61,"maximum":328.44,"gross_charge":402,"discounted_cash":92.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":213.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":328.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY RUBELLA","code_information":[{"code":"86762","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":114.48,"maximum":176.48,"gross_charge":216,"discounted_cash":49.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.48,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY RUBELLA","code_information":[{"code":"86762","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":176.48,"gross_charge":216,"discounted_cash":49.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY RUBELLA 50772B","code_information":[{"code":"86762","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY RUBELLA 50772B","code_information":[{"code":"86762","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-RUBELLA AB IGG 50771","code_information":[{"code":"86762","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":30.74,"maximum":47.39,"gross_charge":58,"discounted_cash":13.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-RUBELLA AB IGG 50771","code_information":[{"code":"86762","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":58,"discounted_cash":13.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-RUBELLA AB IGM 50551","code_information":[{"code":"86762","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":120.84,"maximum":186.28,"gross_charge":228,"discounted_cash":52.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":186.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-RUBELLA AB IGM 50551","code_information":[{"code":"86762","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":186.28,"gross_charge":228,"discounted_cash":52.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":186.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY RUBEOLA","code_information":[{"code":"86765","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":65.19,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY RUBEOLA","code_information":[{"code":"86765","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY RUBEOLA 3017752C","code_information":[{"code":"86765","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-ANTIBODY RUBEOLA 3017752C","code_information":[{"code":"86765","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":62.7,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-MEASLES RUBEOLA IGM 99597","code_information":[{"code":"86765","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":93.81,"maximum":144.61,"gross_charge":177,"discounted_cash":40.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-MEASLES RUBEOLA IGM 99597","code_information":[{"code":"86765","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":144.61,"gross_charge":177,"discounted_cash":40.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB SALMONELLA 2010805C","code_information":[{"code":"86768","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":52.47,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB SALMONELLA 2010805C","code_information":[{"code":"86768","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-S TYPHI PARATYPHI 2010798","code_information":[{"code":"86768","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":189.21,"maximum":291.67,"gross_charge":357,"discounted_cash":81.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-S TYPHI PARATYPHI 2010798","code_information":[{"code":"86768","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.91,"maximum":291.67,"gross_charge":357,"discounted_cash":81.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"UC SARS-COV-2 AB","code_information":[{"code":"86769","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":38.4,"gross_charge":47,"discounted_cash":10.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"UC SARS-COV-2 AB","code_information":[{"code":"86769","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":301.52,"gross_charge":47,"discounted_cash":10.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":301.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":301.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":86.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":86.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.13,"methodology":"fee schedule"}]}]},{"description":"RL-A AB TOXOPLASMA 50772C","code_information":[{"code":"86777","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A AB TOXOPLASMA 50772C","code_information":[{"code":"86777","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-TOXOPLASMA AB IGG 50770","code_information":[{"code":"86777","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":47.17,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-TOXOPLASMA AB IGG 50770","code_information":[{"code":"86777","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-TOXOPLASMA AB IGM 50557","code_information":[{"code":"86778","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":47.17,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-TOXOPLASMA AB IGM 50557","code_information":[{"code":"86778","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.64,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY TREPONEMA PALLIDUM","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":64.13,"maximum":98.86,"gross_charge":121,"discounted_cash":27.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.86,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY TREPONEMA PALLIDUM","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.94,"maximum":98.86,"gross_charge":121,"discounted_cash":27.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"RL-A-T PALLIDUM AB IGG 50477","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":63.6,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-T PALLIDUM AB IGG 50477","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.94,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"RL-A-T PALLIDUM AB TP-PA 50777","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":81.62,"maximum":125.82,"gross_charge":154,"discounted_cash":35.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-T PALLIDUM AB TP-PA 50777","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.94,"maximum":125.82,"gross_charge":154,"discounted_cash":35.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"RL-A-T PALLIDUM IGG CSF 55273","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-T PALLIDUM IGG CSF 55273","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.94,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY VARICELLA ZOSTER","code_information":[{"code":"86787","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"ANTIBODY VARICELLA ZOSTER","code_information":[{"code":"86787","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB VARICELLA ZOS 3017752D","code_information":[{"code":"86787","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":66.78,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB VARICELLA ZOS 3017752D","code_information":[{"code":"86787","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-VARICEL ZOS IGG CSF 54444","code_information":[{"code":"86787","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":27.56,"maximum":42.49,"gross_charge":52,"discounted_cash":11.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"RL-A-VARICEL ZOS IGG CSF 54444","code_information":[{"code":"86787","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":62.7,"gross_charge":52,"discounted_cash":11.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-VARICELLA ZOST IGM 99314","code_information":[{"code":"86787","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-VARICELLA ZOST IGM 99314","code_information":[{"code":"86787","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 2001592E","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 2001592E","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 2001594C","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 2001594C","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":82.02,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 2001597F","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 2001597F","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":82.02,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 3017752E","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 3017752E","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":82.02,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 50226A","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":52.47,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE IGM 50226A","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":82.02,"gross_charge":99,"discounted_cash":22.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE IGM CSF 50239","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":40.28,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE IGM CSF 50239","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":82.02,"gross_charge":76,"discounted_cash":17.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE IGM SERUM 50236","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":137.8,"maximum":212.42,"gross_charge":260,"discounted_cash":59.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE IGM SERUM 50236","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":212.42,"gross_charge":260,"discounted_cash":59.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIR 2001593E","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":45.58,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIR 2001593E","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIR 2001594D","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIR 2001594D","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIR 2001597E","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIR 2001597E","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIR 3017752F","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIR 3017752F","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIRUS 50226B","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-AB WEST NILE VIRUS 50226B","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE IGG CSF 50238","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE IGG CSF 50238","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":70.07,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE IGG SERUM 50234","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":137.8,"maximum":212.42,"gross_charge":260,"discounted_cash":59.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE IGG SERUM 50234","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.63,"maximum":212.42,"gross_charge":260,"discounted_cash":59.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-DENGUE FEVER IGG IGM93096","code_information":[{"code":"86790","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":41.87,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"}]}]},{"description":"RL-A-DENGUE FEVER IGG IGM93096","code_information":[{"code":"86790","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATIT E AB IGG 2010151","code_information":[{"code":"86790","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":84.27,"maximum":129.91,"gross_charge":159,"discounted_cash":36.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATIT E AB IGG 2010151","code_information":[{"code":"86790","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":129.91,"gross_charge":159,"discounted_cash":36.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"minimum":9393.74,"maximum":22631.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20607,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20607,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21745.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16309.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16309.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19937.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16441.83,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22631.11,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9393.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9487.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9675.56,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9581.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9393.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9393.74,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9393.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9628.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9393.74,"methodology":"case rate"}]}]},{"description":"RL-A-THYROGLOBULIN AB 2006685","code_information":[{"code":"86800","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":139.92,"maximum":215.69,"gross_charge":264,"discounted_cash":60.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-THYROGLOBULIN AB 2006685","code_information":[{"code":"86800","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":215.69,"gross_charge":264,"discounted_cash":60.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-THYROGLOBULIN AB 50645B","code_information":[{"code":"86800","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":33.92,"maximum":52.29,"gross_charge":64,"discounted_cash":14.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-THYROGLOBULIN AB 50645B","code_information":[{"code":"86800","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":77.44,"gross_charge":64,"discounted_cash":14.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"}]}]},{"description":"THYROGLOBULIN ANTIBODY","code_information":[{"code":"86800","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":110.24,"maximum":169.94,"gross_charge":208,"discounted_cash":47.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":110.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.94,"methodology":"fee schedule"}]}]},{"description":"THYROGLOBULIN ANTIBODY","code_information":[{"code":"86800","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":169.94,"gross_charge":208,"discounted_cash":47.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":110.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS C ANTIBODY","code_information":[{"code":"86803","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":163.77,"maximum":252.46,"gross_charge":309,"discounted_cash":70.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":163.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":252.46,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS C ANTIBODY","code_information":[{"code":"86803","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.56,"maximum":252.46,"gross_charge":309,"discounted_cash":70.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":163.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":252.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-HCV AB CIA RFLX 2010784","code_information":[{"code":"86803","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":30.21,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-HCV AB CIA RFLX 2010784","code_information":[{"code":"86803","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.56,"maximum":69.42,"gross_charge":57,"discounted_cash":13.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"}]}]},{"description":"LYMPHOCYTOTOXICITY ASSAY","code_information":[{"code":"86806","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":109.18,"maximum":168.31,"gross_charge":206,"discounted_cash":47.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":168.31,"methodology":"fee schedule"}]}]},{"description":"LYMPHOCYTOTOXICITY ASSAY","code_information":[{"code":"86806","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.55,"maximum":231.6,"gross_charge":206,"discounted_cash":47.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":111.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":111.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":139.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":168.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":48.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":48.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":47.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-HLA-B27 95840","code_information":[{"code":"86812","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":221.01,"maximum":340.69,"gross_charge":417,"discounted_cash":95.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":221.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":340.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-HLA-B27 95840","code_information":[{"code":"86812","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.48,"maximum":340.69,"gross_charge":417,"discounted_cash":95.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":221.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":340.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"}]}]},{"description":"HLA TYPING A/B/C MULTI ANTIGEN","code_information":[{"code":"86813","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":133.03,"maximum":205.07,"gross_charge":251,"discounted_cash":57.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":133.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":205.07,"methodology":"fee schedule"}]}]},{"description":"HLA TYPING A/B/C MULTI ANTIGEN","code_information":[{"code":"86813","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":34.8,"maximum":282.27,"gross_charge":251,"discounted_cash":57.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":282.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":169.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":133.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":205.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":59.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":59.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":59.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"}]}]},{"description":"HLA CROSSMATCH INITIAL","code_information":[{"code":"86825","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":244.86,"maximum":377.46,"gross_charge":462,"discounted_cash":105.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.46,"methodology":"fee schedule"}]}]},{"description":"HLA CROSSMATCH INITIAL","code_information":[{"code":"86825","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":65.69,"maximum":532.84,"gross_charge":462,"discounted_cash":105.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":257.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":257.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":320.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":109.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":110.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":112.78,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":111.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":109.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":109.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":109.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":112.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":109.49,"methodology":"fee schedule"}]}]},{"description":"HLA CROSSMATCH EA ADDL","code_information":[{"code":"86826","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":297.33,"maximum":458.34,"gross_charge":561,"discounted_cash":128.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":297.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":458.34,"methodology":"fee schedule"}]}]},{"description":"HLA CROSSMATCH EA ADDL","code_information":[{"code":"86826","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":21.91,"maximum":458.34,"gross_charge":561,"discounted_cash":128.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":106.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":297.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":458.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":36.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":36.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":36.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":36.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":36.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":37.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":36.53,"methodology":"fee schedule"}]}]},{"description":"HLA AB SCREEN CLASS I/II","code_information":[{"code":"86828","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":384.78,"maximum":593.15,"gross_charge":726,"discounted_cash":166.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":384.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":593.15,"methodology":"fee schedule"}]}]},{"description":"HLA AB SCREEN CLASS I/II","code_information":[{"code":"86828","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":38.51,"maximum":593.15,"gross_charge":726,"discounted_cash":166.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":150.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":150.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":187.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":384.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":593.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":64.84,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":66.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":64.19,"methodology":"fee schedule"}]}]},{"description":"HLA AB SCREEN CLASS II","code_information":[{"code":"86831","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":292.56,"maximum":450.99,"gross_charge":552,"discounted_cash":126.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":292.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":450.99,"methodology":"fee schedule"}]}]},{"description":"HLA AB SCREEN CLASS II","code_information":[{"code":"86831","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":49.12,"maximum":450.99,"gross_charge":552,"discounted_cash":126.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":398.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":398.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":192.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":192.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":239.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":239.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":292.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":49.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":82.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":84.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":83.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":81.88,"methodology":"fee schedule"}]}]},{"description":"HLA AB SCREEN CLASS I","code_information":[{"code":"86832","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":882.98,"maximum":1361.13,"gross_charge":1666,"discounted_cash":381.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":882.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1361.13,"methodology":"fee schedule"}]}]},{"description":"HLA AB SCREEN CLASS I","code_information":[{"code":"86832","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":194.25,"maximum":1575.61,"gross_charge":1666,"discounted_cash":381.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1575.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1575.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1014.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":760.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":760.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":946.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":946.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":882.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1361.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":194.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":194.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":323.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":326.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":333.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":330.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":323.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":323.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":323.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":331.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":323.75,"methodology":"fee schedule"}]}]},{"description":"HLA AB SCREEN HD CLASS II","code_information":[{"code":"86833","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":509.33,"maximum":785.14,"gross_charge":961,"discounted_cash":220.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":509.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":785.14,"methodology":"fee schedule"}]}]},{"description":"HLA AB SCREEN HD CLASS II","code_information":[{"code":"86833","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":195.48,"maximum":1585.56,"gross_charge":961,"discounted_cash":220.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1585.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1585.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1020.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":765.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":765.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":952.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":952.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":509.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":785.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":195.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":195.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":325.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":329.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":335.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":332.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":325.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":325.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":325.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":333.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":325.8,"methodology":"fee schedule"}]}]},{"description":"AB HLA SEMIQUANT PNL CLASS II","code_information":[{"code":"86835","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":485.48,"maximum":748.38,"gross_charge":916,"discounted_cash":209.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":485.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":748.38,"methodology":"fee schedule"}]}]},{"description":"AB HLA SEMIQUANT PNL CLASS II","code_information":[{"code":"86835","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":193.77,"maximum":1571.75,"gross_charge":916,"discounted_cash":209.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1571.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1571.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1011.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":758.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":758.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":944.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":944.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":485.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":748.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":193.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":193.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":326.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":332.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":331.04,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":322.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-UNLISTED IMMUNO 2012729C","code_information":[{"code":"86849","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":45.58,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-UNLISTED IMMUNO 2012729C","code_information":[{"code":"86849","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.04,"maximum":103.46,"gross_charge":86,"discounted_cash":19.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"}]}]},{"description":"AB SCREEN RBC EACH","code_information":[{"code":"86850","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":148.93,"maximum":229.58,"gross_charge":281,"discounted_cash":64.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":148.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.58,"methodology":"fee schedule"}]}]},{"description":"AB SCREEN RBC EACH","code_information":[{"code":"86850","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":5.86,"maximum":229.58,"gross_charge":281,"discounted_cash":64.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":148.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"AB ELUTION RBC EACH","code_information":[{"code":"86860","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":209.88,"maximum":323.54,"gross_charge":396,"discounted_cash":90.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":209.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":323.54,"methodology":"fee schedule"}]}]},{"description":"AB ELUTION RBC EACH","code_information":[{"code":"86860","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":2.66,"maximum":323.54,"gross_charge":396,"discounted_cash":90.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":209.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":323.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"AB IDENTIFICATION RBC AB PANEL","code_information":[{"code":"86870","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":176.49,"maximum":272.07,"gross_charge":333,"discounted_cash":76.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":176.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.07,"methodology":"fee schedule"}]}]},{"description":"AB IDENTIFICATION RBC AB PANEL","code_information":[{"code":"86870","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":3.65,"maximum":342.99,"gross_charge":333,"discounted_cash":76.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":176.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":336.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":342.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":339.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":341.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"}]}]},{"description":"COOMBS DIRECT EACH","code_information":[{"code":"86880","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":66.25,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"}]}]},{"description":"COOMBS DIRECT EACH","code_information":[{"code":"86880","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":3.23,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"COOMBS INDIRECT TITER","code_information":[{"code":"86886","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":121.9,"maximum":187.91,"gross_charge":230,"discounted_cash":52.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.91,"methodology":"fee schedule"}]}]},{"description":"COOMBS INDIRECT TITER","code_information":[{"code":"86886","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":188.12,"gross_charge":230,"discounted_cash":52.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"BLOOD PROCESSING AUTOLOGOUS","code_information":[{"code":"86890","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":236.38,"maximum":364.39,"gross_charge":446,"discounted_cash":102.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.39,"methodology":"fee schedule"}]}]},{"description":"BLOOD PROCESSING AUTOLOGOUS","code_information":[{"code":"86890","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":8.37,"maximum":464.49,"gross_charge":446,"discounted_cash":102.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":464.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":99.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":99.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"minimum":6837.98,"maximum":149913.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13947,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13947,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149913.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":112437.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":112437.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13494.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11128.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15317.77,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6837.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6906.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7043.12,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6974.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6837.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6837.98,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6837.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7008.93,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6837.98,"methodology":"case rate"}]}]},{"description":"BLOOD TYPING SEROLOGIC ABO","code_information":[{"code":"86900","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"BLOOD TYPING SEROLOGIC ABO","code_information":[{"code":"86900","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":1.79,"maximum":84.46,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":82.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":83.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":84.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"}]}]},{"description":"BLOOD TYPING SEROLOGIC RH (D)","code_information":[{"code":"86901","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":52.47,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"}]}]},{"description":"BLOOD TYPING SEROLOGIC RH (D)","code_information":[{"code":"86901","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":1.79,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"}]}]},{"description":"BLD TYPING AG TEST REAG SERUM","code_information":[{"code":"86902","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"BLD TYPING AG TEST REAG SERUM","code_information":[{"code":"86902","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":3.81,"maximum":84.46,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":82.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":83.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":84.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"}]}]},{"description":"BLD TYPING AG SCR PATIENT SRM","code_information":[{"code":"86904","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":75.79,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"}]}]},{"description":"BLD TYPING AG SCR PATIENT SRM","code_information":[{"code":"86904","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":9.8,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"BLD TYPING RBC NON ABO RH(D)","code_information":[{"code":"86905","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":205.64,"maximum":317,"gross_charge":388,"discounted_cash":88.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":205.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317,"methodology":"fee schedule"}]}]},{"description":"BLD TYPING RBC NON ABO RH(D)","code_information":[{"code":"86905","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":2.29,"maximum":394.91,"gross_charge":388,"discounted_cash":88.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":205.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":387.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":394.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":391.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":392.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"}]}]},{"description":"BLOOD TYPING RH PHENOTYPE CMPL","code_information":[{"code":"86906","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"BLOOD TYPING RH PHENOTYPE CMPL","code_information":[{"code":"86906","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":4.65,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"}]}]},{"description":"CROSSMATCH IMMEDIATE SPIN","code_information":[{"code":"86920","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":27.56,"maximum":42.49,"gross_charge":52,"discounted_cash":11.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"CROSSMATCH IMMEDIATE SPIN","code_information":[{"code":"86920","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":163.39,"gross_charge":52,"discounted_cash":11.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":79.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":79.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":52.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":53.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":53.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":53.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"}]}]},{"description":"CROSSMATCH INCUBATION","code_information":[{"code":"86921","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":157.41,"maximum":242.65,"gross_charge":297,"discounted_cash":68.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.65,"methodology":"fee schedule"}]}]},{"description":"CROSSMATCH INCUBATION","code_information":[{"code":"86921","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":2.66,"maximum":242.65,"gross_charge":297,"discounted_cash":68.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":79.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":79.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"CROSSMATCH ANTIGLOBULIN","code_information":[{"code":"86922","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":162.18,"maximum":250.01,"gross_charge":306,"discounted_cash":70.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":162.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.01,"methodology":"fee schedule"}]}]},{"description":"CROSSMATCH ANTIGLOBULIN","code_information":[{"code":"86922","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":3.15,"maximum":250.01,"gross_charge":306,"discounted_cash":70.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":79.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":79.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":162.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"FRESH FROZEN PLASMA THAWING","code_information":[{"code":"86927","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":127.2,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"}]}]},{"description":"FRESH FROZEN PLASMA THAWING","code_information":[{"code":"86927","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":1.67,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"VOL REDUCTION OF BLOOD/PROD","code_information":[{"code":"86960","type":"CPT"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":72.61,"maximum":111.93,"gross_charge":137,"discounted_cash":31.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"}]}]},{"description":"VOL REDUCTION OF BLOOD/PROD","code_information":[{"code":"86960","type":"CPT"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":2.75,"maximum":626.47,"gross_charge":137,"discounted_cash":31.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":469.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":469.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"}]}]},{"description":"PRETREAT RBC CHEMICALS/DRUGS","code_information":[{"code":"86970","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":124.02,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"}]}]},{"description":"PRETREAT RBC CHEMICALS/DRUGS","code_information":[{"code":"86970","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":2.48,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"PRETREAT RBC INCUBAT ENZYMES","code_information":[{"code":"86971","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":224.72,"maximum":346.41,"gross_charge":424,"discounted_cash":97.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":224.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":346.41,"methodology":"fee schedule"}]}]},{"description":"PRETREAT RBC INCUBAT ENZYMES","code_information":[{"code":"86971","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":1.98,"maximum":346.41,"gross_charge":424,"discounted_cash":97.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":224.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":346.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"PRETREAT SERUM RBC INHIBITORS","code_information":[{"code":"86977","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":107.06,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"}]}]},{"description":"PRETREAT SERUM RBC INHIBITORS","code_information":[{"code":"86977","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":188.12,"gross_charge":202,"discounted_cash":46.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"PRETREAT SERUM RBC ABSORPTION","code_information":[{"code":"86978","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":106.53,"maximum":164.22,"gross_charge":201,"discounted_cash":46.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.22,"methodology":"fee schedule"}]}]},{"description":"PRETREAT SERUM RBC ABSORPTION","code_information":[{"code":"86978","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":164.22,"gross_charge":201,"discounted_cash":46.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":95.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":95.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"SPLITTING BLOOD PRODUCT EACH","code_information":[{"code":"86985","type":"CPT"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":365.7,"maximum":563.73,"gross_charge":690,"discounted_cash":158.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":365.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":563.73,"methodology":"fee schedule"}]}]},{"description":"SPLITTING BLOOD PRODUCT EACH","code_information":[{"code":"86985","type":"CPT"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":2.16,"maximum":563.73,"gross_charge":690,"discounted_cash":158.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":365.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":563.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RED CELL SEPARATION","code_information":[{"code":"86999","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":366.76,"maximum":565.37,"gross_charge":692,"discounted_cash":158.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":366.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":565.37,"methodology":"fee schedule"}]}]},{"description":"RED CELL SEPARATION","code_information":[{"code":"86999","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.02,"maximum":565.37,"gross_charge":692,"discounted_cash":158.47,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":167.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":167.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":72.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":366.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":565.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"}]}]},{"description":"SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"minimum":25225.98,"maximum":130470.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118801,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118801,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33634,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25225.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25225.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":114944.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":94788.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":130470.3,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":55068.05,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":55618.74,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":56720.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":56169.42,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":55068.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":55068.05,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":55068.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":56444.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":55068.05,"methodology":"case rate"}]}]},{"description":"CONCENTRATION AFB","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":20.14,"maximum":31.05,"gross_charge":38,"discounted_cash":8.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"}]}]},{"description":"CONCENTRATION AFB","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4,"maximum":32.49,"gross_charge":38,"discounted_cash":8.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL PROCESSING FEE 62151","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":14.84,"maximum":22.88,"gross_charge":28,"discounted_cash":6.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL PROCESSING FEE 62151","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4,"maximum":32.49,"gross_charge":28,"discounted_cash":6.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK AFBC 2010182","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":40.28,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK AFBC 2010182","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-CONCENT INFEC AGNT 60050A","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":16.96,"maximum":26.15,"gross_charge":32,"discounted_cash":7.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-CONCENT INFEC AGNT 60050A","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4,"maximum":32.49,"gross_charge":32,"discounted_cash":7.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-CONCENT INFEC AGNT 60052A","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":104.94,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-CONCENT INFEC AGNT 60052A","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"CULTURE BLOOD","code_information":[{"code":"87040","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":312.17,"maximum":481.22,"gross_charge":589,"discounted_cash":134.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":312.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":481.22,"methodology":"fee schedule"}]}]},{"description":"CULTURE BLOOD","code_information":[{"code":"87040","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.19,"maximum":481.22,"gross_charge":589,"discounted_cash":134.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":312.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":481.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"}]}]},{"description":"CULTURE STOOL SALM SHIG","code_information":[{"code":"87045","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":216.24,"maximum":333.34,"gross_charge":408,"discounted_cash":93.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":216.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.34,"methodology":"fee schedule"}]}]},{"description":"CULTURE STOOL SALM SHIG","code_information":[{"code":"87045","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.66,"maximum":333.34,"gross_charge":408,"discounted_cash":93.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":216.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"}]}]},{"description":"CULTURE STOOL VIBRIO","code_information":[{"code":"87046","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":66.25,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"}]}]},{"description":"CULTURE STOOL VIBRIO","code_information":[{"code":"87046","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.66,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"}]}]},{"description":"CULT UTERUS/PLACENTA","code_information":[{"code":"87070","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":243.8,"maximum":375.82,"gross_charge":460,"discounted_cash":105.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":243.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":375.82,"methodology":"fee schedule"}]}]},{"description":"CULT UTERUS/PLACENTA","code_information":[{"code":"87070","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.17,"maximum":375.82,"gross_charge":460,"discounted_cash":105.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":243.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":375.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"}]}]},{"description":"CULTURE GASTRIC","code_information":[{"code":"87070","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":165.36,"maximum":254.91,"gross_charge":312,"discounted_cash":71.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.91,"methodology":"fee schedule"}]}]},{"description":"CULTURE GASTRIC","code_information":[{"code":"87070","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.17,"maximum":254.91,"gross_charge":312,"discounted_cash":71.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"}]}]},{"description":"CULTURE WOUND","code_information":[{"code":"87070","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":150.52,"maximum":232.03,"gross_charge":284,"discounted_cash":65.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":150.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.03,"methodology":"fee schedule"}]}]},{"description":"CULTURE WOUND","code_information":[{"code":"87070","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.17,"maximum":232.03,"gross_charge":284,"discounted_cash":65.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":150.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"}]}]},{"description":"CULTURE AEROBIC OTHER QN","code_information":[{"code":"87071","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":158.47,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"}]}]},{"description":"CULTURE AEROBIC OTHER QN","code_information":[{"code":"87071","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.93,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"}]}]},{"description":"CULTURE ANAEROBIC","code_information":[{"code":"87075","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":150.52,"maximum":232.03,"gross_charge":284,"discounted_cash":65.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":150.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.03,"methodology":"fee schedule"}]}]},{"description":"CULTURE ANAEROBIC","code_information":[{"code":"87075","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.68,"maximum":232.03,"gross_charge":284,"discounted_cash":65.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":150.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"}]}]},{"description":"CULTURE ANAEROBIC DEF ID","code_information":[{"code":"87076","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":20.14,"maximum":31.05,"gross_charge":38,"discounted_cash":8.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"}]}]},{"description":"CULTURE ANAEROBIC DEF ID","code_information":[{"code":"87076","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.84,"maximum":39.29,"gross_charge":38,"discounted_cash":8.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL ANAEROBIC ID 62028","code_information":[{"code":"87076","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":14.31,"maximum":22.06,"gross_charge":27,"discounted_cash":6.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL ANAEROBIC ID 62028","code_information":[{"code":"87076","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.84,"maximum":39.29,"gross_charge":27,"discounted_cash":6.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"}]}]},{"description":"CULTURE AEROBIC DEF ID","code_information":[{"code":"87077","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":114.48,"maximum":176.48,"gross_charge":216,"discounted_cash":49.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.48,"methodology":"fee schedule"}]}]},{"description":"CULTURE AEROBIC DEF ID","code_information":[{"code":"87077","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.84,"maximum":176.48,"gross_charge":216,"discounted_cash":49.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-AEROBIC ORG ID W RF 65070","code_information":[{"code":"87077","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":14.84,"maximum":22.88,"gross_charge":28,"discounted_cash":6.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"}]}]},{"description":"RL-A-AEROBIC ORG ID W RF 65070","code_information":[{"code":"87077","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.84,"maximum":39.29,"gross_charge":28,"discounted_cash":6.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-AEROBIC ORGANISM ID 60115","code_information":[{"code":"87077","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-AEROBIC ORGANISM ID 60115","code_information":[{"code":"87077","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.84,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"}]}]},{"description":"CULTURE SCREEN PERTUSSIS","code_information":[{"code":"87081","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":124.55,"maximum":192,"gross_charge":235,"discounted_cash":53.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192,"methodology":"fee schedule"}]}]},{"description":"CULTURE SCREEN PERTUSSIS","code_information":[{"code":"87081","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.97,"maximum":192,"gross_charge":235,"discounted_cash":53.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACANTH NAEGLER CULT 60245","code_information":[{"code":"87081","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":98.05,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACANTH NAEGLER CULT 60245","code_information":[{"code":"87081","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.97,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-C DIPHTHERIAE CULT 60360","code_information":[{"code":"87081","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":89.04,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-C DIPHTHERIAE CULT 60360","code_information":[{"code":"87081","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.97,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"}]}]},{"description":"CULTURE URINE W COLONY COUNT","code_information":[{"code":"87086","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":96.99,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"}]}]},{"description":"CULTURE URINE W COLONY COUNT","code_information":[{"code":"87086","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.84,"maximum":149.52,"gross_charge":183,"discounted_cash":41.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.32,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"}]}]},{"description":"CULTURE URINE PRESUMPTIVE","code_information":[{"code":"87088","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":40.28,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"}]}]},{"description":"CULTURE URINE PRESUMPTIVE","code_information":[{"code":"87088","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.85,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"}]}]},{"description":"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":16446.26,"maximum":38501.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35058,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35058,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27078.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20309.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20309.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33920,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27972.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38501.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16446.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16610.73,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16939.65,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16775.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16446.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16446.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16446.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16857.42,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16446.26,"methodology":"case rate"}]}]},{"description":"CULTURE FUNGI SKIN/HAIR/NAIL","code_information":[{"code":"87101","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":107.06,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGI SKIN/HAIR/NAIL","code_information":[{"code":"87101","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.62,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGUS OTHER","code_information":[{"code":"87102","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":148.93,"maximum":229.58,"gross_charge":281,"discounted_cash":64.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":148.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.58,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGUS OTHER","code_information":[{"code":"87102","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.04,"maximum":229.58,"gross_charge":281,"discounted_cash":64.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":24.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":148.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGUS BLOOD","code_information":[{"code":"87103","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":196.1,"maximum":302.29,"gross_charge":370,"discounted_cash":84.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":196.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.29,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGUS BLOOD","code_information":[{"code":"87103","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.27,"maximum":302.29,"gross_charge":370,"discounted_cash":84.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":196.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":21.08,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGUS ID YEAST EA","code_information":[{"code":"87106","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":47.7,"maximum":73.53,"gross_charge":90,"discounted_cash":20.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.53,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGUS ID YEAST EA","code_information":[{"code":"87106","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.19,"maximum":73.53,"gross_charge":90,"discounted_cash":20.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGUS ID MOLD","code_information":[{"code":"87107","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":41.87,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"}]}]},{"description":"CULTURE FUNGUS ID MOLD","code_information":[{"code":"87107","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.19,"maximum":64.55,"gross_charge":79,"discounted_cash":18.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-UREAPL MYCOPL CULT 65031","code_information":[{"code":"87109","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":50.35,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"}]}]},{"description":"RL-A-UREAPL MYCOPL CULT 65031","code_information":[{"code":"87109","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":9.23,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"}]}]},{"description":"CULTURE CHLAMYDIA","code_information":[{"code":"87110","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":124.02,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"}]}]},{"description":"CULTURE CHLAMYDIA","code_information":[{"code":"87110","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.76,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-CULTURE CHLAMYDIA 60850A","code_information":[{"code":"87110","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-CULTURE CHLAMYDIA 60850A","code_information":[{"code":"87110","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.76,"maximum":95.4,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"}]}]},{"description":"CULTURE AFB/TB/MYCO ISOL ID","code_information":[{"code":"87116","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":192.39,"maximum":296.58,"gross_charge":363,"discounted_cash":83.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":192.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":296.58,"methodology":"fee schedule"}]}]},{"description":"CULTURE AFB/TB/MYCO ISOL ID","code_information":[{"code":"87116","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.48,"maximum":296.58,"gross_charge":363,"discounted_cash":83.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":192.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":296.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-AFB CULTURE STAIN 60152","code_information":[{"code":"87116","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":39.75,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"}]}]},{"description":"RL-A-AFB CULTURE STAIN 60152","code_information":[{"code":"87116","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.48,"maximum":61.28,"gross_charge":75,"discounted_cash":17.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"}]}]},{"description":"CULTURE TYPING IMMUNOFLUOR HSV","code_information":[{"code":"87140","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"CULTURE TYPING IMMUNOFLUOR HSV","code_information":[{"code":"87140","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.34,"maximum":27.13,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-CULT TYPE IF EA 60850B","code_information":[{"code":"87140","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-CULT TYPE IF EA 60850B","code_information":[{"code":"87140","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.34,"maximum":27.13,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"}]}]},{"description":"CULTURE TYPING STREP","code_information":[{"code":"87147","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"CULTURE TYPING STREP","code_information":[{"code":"87147","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.1,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"CULTURE TYPE ID DIRECT PROBE","code_information":[{"code":"87149","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":60.42,"maximum":93.14,"gross_charge":114,"discounted_cash":26.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"}]}]},{"description":"CULTURE TYPE ID DIRECT PROBE","code_information":[{"code":"87149","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.03,"maximum":97.55,"gross_charge":114,"discounted_cash":26.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK MTBGP 60459","code_information":[{"code":"87149","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK MTBGP 60459","code_information":[{"code":"87149","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.03,"maximum":97.55,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCIDIO IMMITIS ID 62225","code_information":[{"code":"87149","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":128.26,"maximum":197.72,"gross_charge":242,"discounted_cash":55.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCIDIO IMMITIS ID 62225","code_information":[{"code":"87149","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.03,"maximum":197.72,"gross_charge":242,"discounted_cash":55.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL MTB SPEC ID 2014218","code_information":[{"code":"87150","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":74.4,"maximum":114.68,"gross_charge":140.36,"discounted_cash":32.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL MTB SPEC ID 2014218","code_information":[{"code":"87150","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":140.36,"discounted_cash":32.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"CULT TYP ID BY SEQUENCING","code_information":[{"code":"87153","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":694.83,"maximum":1071.09,"gross_charge":1311,"discounted_cash":300.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":694.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1071.09,"methodology":"fee schedule"}]}]},{"description":"CULT TYP ID BY SEQUENCING","code_information":[{"code":"87153","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":69.21,"maximum":1071.09,"gross_charge":1311,"discounted_cash":300.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":561.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":239.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":239.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":337.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":694.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1071.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":69.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":69.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":116.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":118.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":117.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":118.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK BAC SEQ 60719","code_information":[{"code":"87153","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":244.33,"maximum":376.64,"gross_charge":461,"discounted_cash":105.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK BAC SEQ 60719","code_information":[{"code":"87153","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":69.21,"maximum":561.4,"gross_charge":461,"discounted_cash":105.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":561.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":239.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":239.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":337.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":69.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":69.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":116.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":118.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":117.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":118.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"}]}]},{"description":"CULTURE TYPING OTHER METHOD","code_information":[{"code":"87158","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"CULTURE TYPING OTHER METHOD","code_information":[{"code":"87158","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.64,"maximum":37.65,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"}]}]},{"description":"MACROSCOPIC EXAM ARTHROPOD","code_information":[{"code":"87168","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":155.82,"maximum":240.2,"gross_charge":294,"discounted_cash":67.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":155.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":240.2,"methodology":"fee schedule"}]}]},{"description":"MACROSCOPIC EXAM ARTHROPOD","code_information":[{"code":"87168","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":2.56,"maximum":240.2,"gross_charge":294,"discounted_cash":67.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":155.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":240.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"HOMOGENIZATION TISSUE","code_information":[{"code":"87176","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":54.59,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"}]}]},{"description":"HOMOGENIZATION TISSUE","code_information":[{"code":"87176","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.52,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"}]}]},{"description":"OVA PARASITE SMEAR CONCENTR ID","code_information":[{"code":"87177","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":98.05,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"}]}]},{"description":"OVA PARASITE SMEAR CONCENTR ID","code_information":[{"code":"87177","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.34,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-OVA PARA SMR CID 3001662A","code_information":[{"code":"87177","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":41.34,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-OVA PARA SMR CID 3001662A","code_information":[{"code":"87177","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.34,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"}]}]},{"description":"RL-A-OVA PARA SMR CID 60046A","code_information":[{"code":"87177","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":136.21,"maximum":209.97,"gross_charge":257,"discounted_cash":58.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-OVA PARA SMR CID 60046A","code_information":[{"code":"87177","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.34,"maximum":209.97,"gross_charge":257,"discounted_cash":58.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIBILITY AGAR DIL EACH","code_information":[{"code":"87181","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":23.32,"maximum":35.95,"gross_charge":44,"discounted_cash":10.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIBILITY AGAR DIL EACH","code_information":[{"code":"87181","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":35.95,"gross_charge":44,"discounted_cash":10.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIB DISK PER PLATE 1-12","code_information":[{"code":"87184","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":100.7,"maximum":155.23,"gross_charge":190,"discounted_cash":43.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.23,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIB DISK PER PLATE 1-12","code_information":[{"code":"87184","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.48,"maximum":155.23,"gross_charge":190,"discounted_cash":43.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL SUSCEPT BLAC 60401","code_information":[{"code":"87185","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.71,"maximum":5.72,"gross_charge":7,"discounted_cash":1.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL SUSCEPT BLAC 60401","code_information":[{"code":"87185","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":23.12,"gross_charge":7,"discounted_cash":1.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIBILITY B-LACTAM EA","code_information":[{"code":"87185","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.19,"maximum":18.8,"gross_charge":23,"discounted_cash":5.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIBILITY B-LACTAM EA","code_information":[{"code":"87185","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":23.12,"gross_charge":23,"discounted_cash":5.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL SUS AFB/NOC 60492","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL SUS AFB/NOC 60492","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.19,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL SUS SINGL BDIL 62229","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":137.27,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL SUS SINGL BDIL 62229","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.19,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK MIC 60408","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":31.87,"gross_charge":39,"discounted_cash":8.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK MIC 60408","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.19,"maximum":42.08,"gross_charge":39,"discounted_cash":8.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-SUSCEPTIB NOCARDIA 60193","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":124.02,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-SUSCEPTIB NOCARDIA 60193","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.19,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-SUSCEPTIBILITY NOS 60200","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":16.43,"maximum":25.33,"gross_charge":31,"discounted_cash":7.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-SUSCEPTIBILITY NOS 60200","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.19,"maximum":42.08,"gross_charge":31,"discounted_cash":7.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIBILITY MIC PER PLATE","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":177.55,"maximum":273.7,"gross_charge":335,"discounted_cash":76.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":177.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":273.7,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIBILITY MIC PER PLATE","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.19,"maximum":273.7,"gross_charge":335,"discounted_cash":76.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":177.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":273.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"}]}]},{"description":"SUSCEPT MICROBE MLC","code_information":[{"code":"87187","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":103.88,"maximum":160.14,"gross_charge":196,"discounted_cash":44.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"}]}]},{"description":"SUSCEPT MICROBE MLC","code_information":[{"code":"87187","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":24.1,"maximum":195.53,"gross_charge":196,"discounted_cash":44.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":83.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":83.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":40.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK TBMIC 60409","code_information":[{"code":"87188","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":95.4,"maximum":147.06,"gross_charge":180,"discounted_cash":41.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-BILL TASK TBMIC 60409","code_information":[{"code":"87188","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.98,"maximum":147.06,"gross_charge":180,"discounted_cash":41.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIBILITY MACROBROTH DIL","code_information":[{"code":"87188","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":119.78,"maximum":184.65,"gross_charge":226,"discounted_cash":51.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":119.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":184.65,"methodology":"fee schedule"}]}]},{"description":"SUSCEPTIBILITY MACROBROTH DIL","code_information":[{"code":"87188","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.98,"maximum":184.65,"gross_charge":226,"discounted_cash":51.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":119.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":184.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"}]}]},{"description":"SUSCEPT MYCOBACTERIA PROPORATN","code_information":[{"code":"87190","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":82.68,"maximum":127.46,"gross_charge":156,"discounted_cash":35.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.46,"methodology":"fee schedule"}]}]},{"description":"SUSCEPT MYCOBACTERIA PROPORATN","code_information":[{"code":"87190","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.38,"maximum":127.46,"gross_charge":156,"discounted_cash":35.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"}]}]},{"description":"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"minimum":9246.04,"maximum":51195.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19523,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19523,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51195.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38397.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38397.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18889.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15577.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21440.75,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9246.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9338.51,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9523.43,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9430.97,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9246.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9246.04,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9246.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9477.2,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9246.04,"methodology":"case rate"}]}]},{"description":"SMEAR GRAM/GEIMSA","code_information":[{"code":"87205","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":137.27,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"}]}]},{"description":"SMEAR GRAM/GEIMSA","code_information":[{"code":"87205","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":2.56,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"SMEAR ACID FAST/FLUORESCENT","code_information":[{"code":"87206","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":151.58,"maximum":233.67,"gross_charge":286,"discounted_cash":65.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":151.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":233.67,"methodology":"fee schedule"}]}]},{"description":"SMEAR ACID FAST/FLUORESCENT","code_information":[{"code":"87206","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.23,"maximum":233.67,"gross_charge":286,"discounted_cash":65.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":151.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":233.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-SMEAR SPECIAL STN 60046B","code_information":[{"code":"87207","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-SMEAR SPECIAL STN 60046B","code_information":[{"code":"87207","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.59,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-SMEAR SPECIAL STN 60050B","code_information":[{"code":"87207","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":16.96,"maximum":26.15,"gross_charge":32,"discounted_cash":7.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-SMEAR SPECIAL STN 60050B","code_information":[{"code":"87207","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.59,"maximum":46.3,"gross_charge":32,"discounted_cash":7.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"}]}]},{"description":"SMEAR OTHER","code_information":[{"code":"87207","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":158.47,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"}]}]},{"description":"SMEAR OTHER","code_information":[{"code":"87207","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.59,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"}]}]},{"description":"RL-A-SMEAR COMPLEX 3001662B","code_information":[{"code":"87209","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-SMEAR COMPLEX 3001662B","code_information":[{"code":"87209","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":10.78,"maximum":87.53,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"SMEAR TRICHROME","code_information":[{"code":"87209","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":144.69,"maximum":223.05,"gross_charge":273,"discounted_cash":62.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.05,"methodology":"fee schedule"}]}]},{"description":"SMEAR TRICHROME","code_information":[{"code":"87209","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":10.78,"maximum":223.05,"gross_charge":273,"discounted_cash":62.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"SMEAR INDIA INK STAIN","code_information":[{"code":"87210","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":176.49,"maximum":272.07,"gross_charge":333,"discounted_cash":76.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":176.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.07,"methodology":"fee schedule"}]}]},{"description":"SMEAR INDIA INK STAIN","code_information":[{"code":"87210","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.49,"maximum":272.07,"gross_charge":333,"discounted_cash":76.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":176.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"}]}]},{"description":"SMEAR WET MOUNT INFECT","code_information":[{"code":"87210","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":182.32,"maximum":281.05,"gross_charge":344,"discounted_cash":78.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":182.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.05,"methodology":"fee schedule"}]}]},{"description":"SMEAR WET MOUNT INFECT","code_information":[{"code":"87210","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.49,"maximum":281.05,"gross_charge":344,"discounted_cash":78.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":182.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"}]}]},{"description":"TISSUE EXAM FUNGI/ECTOPARASITE","code_information":[{"code":"87220","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":147.34,"maximum":227.13,"gross_charge":278,"discounted_cash":63.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.13,"methodology":"fee schedule"}]}]},{"description":"TISSUE EXAM FUNGI/ECTOPARASITE","code_information":[{"code":"87220","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":2.56,"maximum":227.13,"gross_charge":278,"discounted_cash":63.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-CULT VIRUS ID TIS2006496A","code_information":[{"code":"87252","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"RL-A-CULT VIRUS ID TIS2006496A","code_information":[{"code":"87252","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":15.64,"maximum":126.89,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-RF CULT VIRUS ID 60285A","code_information":[{"code":"87252","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":167.48,"maximum":258.18,"gross_charge":316,"discounted_cash":72.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":167.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-RF CULT VIRUS ID 60285A","code_information":[{"code":"87252","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":15.64,"maximum":258.18,"gross_charge":316,"discounted_cash":72.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":167.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-VIRAL CUL NONRESP 2006498","code_information":[{"code":"87252","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":404.92,"maximum":624.19,"gross_charge":764,"discounted_cash":174.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":404.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":624.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-VIRAL CUL NONRESP 2006498","code_information":[{"code":"87252","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":15.64,"maximum":624.19,"gross_charge":764,"discounted_cash":174.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":404.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":624.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-TASK VID 2006696","code_information":[{"code":"87253","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"RL-A-TASK VID 2006696","code_information":[{"code":"87253","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.12,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":59.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEGALOVIR RAPID 65004","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":155.29,"maximum":239.39,"gross_charge":293,"discounted_cash":67.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":155.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":239.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEGALOVIR RAPID 65004","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.73,"maximum":239.39,"gross_charge":293,"discounted_cash":67.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":155.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":239.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-VIRUS SHELL ID 2006496B","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-VIRUS SHELL ID 2006496B","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.73,"maximum":95.19,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-VIRUS SHELL ID 60285B","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":43.99,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-VIRUS SHELL ID 60285B","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.73,"maximum":95.19,"gross_charge":83,"discounted_cash":19.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"}]}]},{"description":"VIRUS ISOLATE SHELL ID","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":50.88,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"}]}]},{"description":"VIRUS ISOLATE SHELL ID","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.73,"maximum":95.19,"gross_charge":96,"discounted_cash":21.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-HERPES SIM VIR CUL 65005","code_information":[{"code":"87255","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":71.55,"maximum":110.3,"gross_charge":135,"discounted_cash":30.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-HERPES SIM VIR CUL 65005","code_information":[{"code":"87255","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":20.31,"maximum":164.75,"gross_charge":135,"discounted_cash":30.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":70.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":70.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":99.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"}]}]},{"description":"VIRUS ISOLATION HSV","code_information":[{"code":"87255","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":227.9,"maximum":351.31,"gross_charge":430,"discounted_cash":98.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":351.31,"methodology":"fee schedule"}]}]},{"description":"VIRUS ISOLATION HSV","code_information":[{"code":"87255","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":20.31,"maximum":351.31,"gross_charge":430,"discounted_cash":98.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":70.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":70.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":99.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":351.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"methodology":"fee schedule"}]}]},{"description":"IF BORDETELLA P AG","code_information":[{"code":"87265","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"}]}]},{"description":"IF BORDETELLA P AG","code_information":[{"code":"87265","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"IF HERPES SIMPLEX TYPE 2 AG","code_information":[{"code":"87273","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":94.34,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"}]}]},{"description":"IF HERPES SIMPLEX TYPE 2 AG","code_information":[{"code":"87273","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-HERPES SIMPLEX 2 AG60280B","code_information":[{"code":"87273","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":27.03,"maximum":41.67,"gross_charge":51,"discounted_cash":11.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-HERPES SIMPLEX 2 AG60280B","code_information":[{"code":"87273","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":58.33,"gross_charge":51,"discounted_cash":11.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-HERPES SIMPLEX 1 AG60280A","code_information":[{"code":"87274","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-HERPES SIMPLEX 1 AG60280A","code_information":[{"code":"87274","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":58.33,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-L PNEUPHILA DFA 2004598","code_information":[{"code":"87278","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":39.22,"maximum":60.46,"gross_charge":74,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-L PNEUPHILA DFA 2004598","code_information":[{"code":"87278","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":9.36,"maximum":75.94,"gross_charge":74,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":45.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"}]}]},{"description":"IF PNEUMOCYSTIS CARINII AG","code_information":[{"code":"87281","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":127.73,"maximum":196.9,"gross_charge":241,"discounted_cash":55.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.9,"methodology":"fee schedule"}]}]},{"description":"IF PNEUMOCYSTIS CARINII AG","code_information":[{"code":"87281","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":196.9,"gross_charge":241,"discounted_cash":55.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-PNEUMOCYSTIS AG IF 60052B","code_information":[{"code":"87281","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":144.16,"maximum":222.23,"gross_charge":272,"discounted_cash":62.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-PNEUMOCYSTIS AG IF 60052B","code_information":[{"code":"87281","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":222.23,"gross_charge":272,"discounted_cash":62.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"IF VARICELLA-ZOSTER AG","code_information":[{"code":"87290","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":124.02,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"}]}]},{"description":"IF VARICELLA-ZOSTER AG","code_information":[{"code":"87290","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.05,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-VARICEL ZOST W RFLX 60282","code_information":[{"code":"87290","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":114.48,"maximum":176.48,"gross_charge":216,"discounted_cash":49.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.48,"methodology":"fee schedule"}]}]},{"description":"RL-A-VARICEL ZOST W RFLX 60282","code_information":[{"code":"87290","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.05,"maximum":176.48,"gross_charge":216,"discounted_cash":49.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"}]}]},{"description":"IF POLYVALENT MULT ORG AG","code_information":[{"code":"87300","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"IF POLYVALENT MULT ORG AG","code_information":[{"code":"87300","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"IA ASPIRGILLUS QL","code_information":[{"code":"87305","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":251.22,"maximum":387.26,"gross_charge":474,"discounted_cash":108.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":251.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":387.26,"methodology":"fee schedule"}]}]},{"description":"IA ASPIRGILLUS QL","code_information":[{"code":"87305","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":387.26,"gross_charge":474,"discounted_cash":108.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":251.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":387.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERG GAL BRONCH 2003150","code_information":[{"code":"87305","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.44,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERG GAL BRONCH 2003150","code_information":[{"code":"87305","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":58.33,"gross_charge":48,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERG GALAC EIA SRM60068","code_information":[{"code":"87305","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":227.9,"maximum":351.31,"gross_charge":430,"discounted_cash":98.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":351.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-ASPERG GALAC EIA SRM60068","code_information":[{"code":"87305","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":351.31,"gross_charge":430,"discounted_cash":98.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":351.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"IA CLOSTRIDIUM DIFF TOXIN QL","code_information":[{"code":"87324","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":131.97,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"}]}]},{"description":"IA CLOSTRIDIUM DIFF TOXIN QL","code_information":[{"code":"87324","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":203.44,"gross_charge":249,"discounted_cash":57.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"IA CRYPTOCOCCUS NEOFORMANS QL","code_information":[{"code":"87327","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"IA CRYPTOCOCCUS NEOFORMANS QL","code_information":[{"code":"87327","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.05,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-CRYTOCOCCUS AG SRM 50196","code_information":[{"code":"87327","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":111.3,"maximum":171.57,"gross_charge":210,"discounted_cash":48.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-CRYTOCOCCUS AG SRM 50196","code_information":[{"code":"87327","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.05,"maximum":171.57,"gross_charge":210,"discounted_cash":48.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-H PYLORI AG FEC EIA 65147","code_information":[{"code":"87338","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-H PYLORI AG FEC EIA 65147","code_information":[{"code":"87338","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.62,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"}]}]},{"description":"IA HEPATITIS B SURFACE AG QL","code_information":[{"code":"87340","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":112.89,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"}]}]},{"description":"IA HEPATITIS B SURFACE AG QL","code_information":[{"code":"87340","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.19,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEP B SURF AG CONFIR20128","code_information":[{"code":"87341","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":67.31,"maximum":103.76,"gross_charge":127,"discounted_cash":29.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEP B SURF AG CONFIR20128","code_information":[{"code":"87341","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.19,"maximum":103.76,"gross_charge":127,"discounted_cash":29.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS BE AG 20094","code_information":[{"code":"87350","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEPATITIS BE AG 20094","code_information":[{"code":"87350","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA HEP DELTA AG QL2006450","code_information":[{"code":"87380","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":69.43,"maximum":107.03,"gross_charge":131,"discounted_cash":30,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.03,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA HEP DELTA AG QL2006450","code_information":[{"code":"87380","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.01,"maximum":107.03,"gross_charge":131,"discounted_cash":30,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18.92,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-H GALACTOMAN AG U 2009418","code_information":[{"code":"87385","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":143.1,"maximum":220.59,"gross_charge":270,"discounted_cash":61.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-H GALACTOMAN AG U 2009418","code_information":[{"code":"87385","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":220.59,"gross_charge":270,"discounted_cash":61.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTOPLASMA AG SRM 92522","code_information":[{"code":"87385","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"}]}]},{"description":"RL-A-HISTOPLASMA AG SRM 92522","code_information":[{"code":"87385","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":198.54,"gross_charge":243,"discounted_cash":55.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":198.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"IA HIV1 AG W HIV1 HIV2 AB","code_information":[{"code":"87389","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":100.7,"maximum":155.23,"gross_charge":190,"discounted_cash":43.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.23,"methodology":"fee schedule"}]}]},{"description":"IA HIV1 AG W HIV1 HIV2 AB","code_information":[{"code":"87389","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":14.44,"maximum":155.23,"gross_charge":190,"discounted_cash":43.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.81,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"}]}]},{"description":"IA RESP SYNCYTIAL VIRUS QL","code_information":[{"code":"87420","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":176.49,"maximum":272.07,"gross_charge":333,"discounted_cash":76.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":176.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.07,"methodology":"fee schedule"}]}]},{"description":"IA RESP SYNCYTIAL VIRUS QL","code_information":[{"code":"87420","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.34,"maximum":272.07,"gross_charge":333,"discounted_cash":76.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":176.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"}]}]},{"description":"IA ROTAVIRUS QL","code_information":[{"code":"87425","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":126.14,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"}]}]},{"description":"IA ROTAVIRUS QL","code_information":[{"code":"87425","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"SARSCOV CORONAVIRUS AG IA","code_information":[{"code":"87426","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"SARSCOV CORONAVIRUS AG IA","code_information":[{"code":"87426","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.19,"maximum":323.71,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":323.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":323.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":90.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":90.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"}]}]},{"description":"IA SHIGA-LIKE TOXIN QL","code_information":[{"code":"87427","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":99.64,"maximum":153.6,"gross_charge":188,"discounted_cash":43.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":99.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":153.6,"methodology":"fee schedule"}]}]},{"description":"IA SHIGA-LIKE TOXIN QL","code_information":[{"code":"87427","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":153.6,"gross_charge":188,"discounted_cash":43.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":99.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":153.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"SARSCOV INF VAB AG IA","code_information":[{"code":"87428","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":148.93,"maximum":229.58,"gross_charge":281,"discounted_cash":64.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":148.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.58,"methodology":"fee schedule"}]}]},{"description":"SARSCOV INF VAB AG IA","code_information":[{"code":"87428","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":29.66,"maximum":525.97,"gross_charge":281,"discounted_cash":64.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":525.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":148.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":72.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":71.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":70.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-D-GLUCAN 2002434","code_information":[{"code":"87449","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":22.26,"maximum":34.32,"gross_charge":42,"discounted_cash":9.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"}]}]},{"description":"RL-A-BETA-D-GLUCAN 2002434","code_information":[{"code":"87449","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":58.33,"gross_charge":42,"discounted_cash":9.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCIDOIDES AG QN 2011075","code_information":[{"code":"87449","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":278.25,"maximum":428.93,"gross_charge":525,"discounted_cash":120.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":278.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":428.93,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCCIDOIDES AG QN 2011075","code_information":[{"code":"87449","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":428.93,"gross_charge":525,"discounted_cash":120.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":278.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":428.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEGIONELLA AG UR 70322","code_information":[{"code":"87449","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":108.12,"maximum":166.67,"gross_charge":204,"discounted_cash":46.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-LEGIONELLA AG UR 70322","code_information":[{"code":"87449","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":166.67,"gross_charge":204,"discounted_cash":46.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"BARTONELLA AMP PROBE","code_information":[{"code":"87471","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":121.37,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"}]}]},{"description":"BARTONELLA AMP PROBE","code_information":[{"code":"87471","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORRELIA SPECIES PCR55570","code_information":[{"code":"87476","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":115.01,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORRELIA SPECIES PCR55570","code_information":[{"code":"87476","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA CANDIDA DIRECT PROBE","code_information":[{"code":"87480","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"IA CANDIDA DIRECT PROBE","code_information":[{"code":"87480","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.03,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-VAGINOS PNL TMA 3002581B","code_information":[{"code":"87481","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":74.2,"maximum":114.38,"gross_charge":140,"discounted_cash":32.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-VAGINOS PNL TMA 3002581B","code_information":[{"code":"87481","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":140,"discounted_cash":32.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":94.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":94.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-MEN/ENCEP PAN PCR 2013305","code_information":[{"code":"87483","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":606.32,"maximum":934.65,"gross_charge":1144,"discounted_cash":261.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":606.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":934.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-MEN/ENCEP PAN PCR 2013305","code_information":[{"code":"87483","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":250.06,"maximum":2028.37,"gross_charge":1144,"discounted_cash":261.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2028.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2028.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":864.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":864.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1219.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1219.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":606.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":934.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":420.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":429.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"}]}]},{"description":"IA CHLAMYDIA TRACH AMP PROBE","code_information":[{"code":"87491","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":152.64,"maximum":235.3,"gross_charge":288,"discounted_cash":65.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":152.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"}]}]},{"description":"IA CHLAMYDIA TRACH AMP PROBE","code_information":[{"code":"87491","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":235.3,"gross_charge":288,"discounted_cash":65.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":152.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA CHLAMYD AMP PRB 60241A","code_information":[{"code":"87491","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":117.35,"maximum":180.89,"gross_charge":221.4,"discounted_cash":50.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":180.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA CHLAMYD AMP PRB 60241A","code_information":[{"code":"87491","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":180.89,"gross_charge":221.4,"discounted_cash":50.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":180.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA CLOSTRID DIFF TOXIN AMP PRB","code_information":[{"code":"87493","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":207.23,"maximum":319.45,"gross_charge":391,"discounted_cash":89.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":207.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":319.45,"methodology":"fee schedule"}]}]},{"description":"IA CLOSTRID DIFF TOXIN AMP PRB","code_information":[{"code":"87493","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":22.36,"maximum":319.45,"gross_charge":391,"discounted_cash":89.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":77.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":77.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":109.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":207.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":319.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"}]}]},{"description":"IA CMV AMPLIFIED PROBE TECHN","code_information":[{"code":"87496","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":297.86,"maximum":459.16,"gross_charge":562,"discounted_cash":128.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":297.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":459.16,"methodology":"fee schedule"}]}]},{"description":"IA CMV AMPLIFIED PROBE TECHN","code_information":[{"code":"87496","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":459.16,"gross_charge":562,"discounted_cash":128.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":297.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":459.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEGALOV QL PCR 60040","code_information":[{"code":"87496","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":115.01,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEGALOV QL PCR 60040","code_information":[{"code":"87496","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA CMV QUANTIFICATION","code_information":[{"code":"87497","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":91.16,"maximum":140.53,"gross_charge":172,"discounted_cash":39.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"}]}]},{"description":"IA CMV QUANTIFICATION","code_information":[{"code":"87497","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":208.48,"gross_charge":172,"discounted_cash":39.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEG NAAT PLAS 3005895","code_information":[{"code":"87497","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":196.1,"maximum":302.29,"gross_charge":370,"discounted_cash":84.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":196.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOMEG NAAT PLAS 3005895","code_information":[{"code":"87497","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":302.29,"gross_charge":370,"discounted_cash":84.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":196.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENTEROVIRUS PCR 50249","code_information":[{"code":"87498","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":165.89,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-ENTEROVIRUS PCR 50249","code_information":[{"code":"87498","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA INFLUENZA MULT RT AMP 1ST 2","code_information":[{"code":"87502","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":210.41,"maximum":324.35,"gross_charge":397,"discounted_cash":90.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":210.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.35,"methodology":"fee schedule"}]}]},{"description":"IA INFLUENZA MULT RT AMP 1ST 2","code_information":[{"code":"87502","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":57.48,"maximum":466.21,"gross_charge":397,"discounted_cash":90.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":466.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":466.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":198.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":198.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":280.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":210.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":57.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":57.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":96.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":98.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":98.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"}]}]},{"description":"IA GI RT AMP PRB 12-25 TARGETS","code_information":[{"code":"87507","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":1212.11,"maximum":1868.48,"gross_charge":2287,"discounted_cash":523.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1212.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1868.48,"methodology":"fee schedule"}]}]},{"description":"IA GI RT AMP PRB 12-25 TARGETS","code_information":[{"code":"87507","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":250.06,"maximum":2028.37,"gross_charge":2287,"discounted_cash":523.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2028.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2028.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":864.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":864.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1219.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1219.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1212.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1868.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":420.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":429.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-GASTRO PATH PCR 3003279","code_information":[{"code":"87507","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":593.6,"maximum":915.04,"gross_charge":1120,"discounted_cash":256.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":593.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":915.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-GASTRO PATH PCR 3003279","code_information":[{"code":"87507","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":250.06,"maximum":2028.37,"gross_charge":1120,"discounted_cash":256.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2028.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2028.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":864.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":864.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1219.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1219.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":593.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":915.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":420.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":429.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"}]}]},{"description":"IA GARDNERELLA VAG DIRCT PROBE","code_information":[{"code":"87510","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":91.16,"maximum":140.53,"gross_charge":172,"discounted_cash":39.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"}]}]},{"description":"IA GARDNERELLA VAG DIRCT PROBE","code_information":[{"code":"87510","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.03,"maximum":140.53,"gross_charge":172,"discounted_cash":39.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"}]}]},{"description":"IA HEPATITIS B QUANTIFICATION","code_information":[{"code":"87517","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":460.04,"maximum":709.16,"gross_charge":868,"discounted_cash":198.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":460.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":709.16,"methodology":"fee schedule"}]}]},{"description":"IA HEPATITIS B QUANTIFICATION","code_information":[{"code":"87517","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":709.16,"gross_charge":868,"discounted_cash":198.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":460.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":709.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"IA HEPATITIS C QUANT RT","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":103.88,"maximum":160.14,"gross_charge":196,"discounted_cash":44.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"}]}]},{"description":"IA HEPATITIS C QUANT RT","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":208.48,"gross_charge":196,"discounted_cash":44.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-HCV QUANT NAAT 3000572","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":279.84,"maximum":431.38,"gross_charge":528,"discounted_cash":120.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":279.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":431.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-HCV QUANT NAAT 3000572","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":431.38,"gross_charge":528,"discounted_cash":120.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":279.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":431.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"IA HSV AMP PROBE","code_information":[{"code":"87529","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":94.34,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"}]}]},{"description":"IA HSV AMP PROBE","code_information":[{"code":"87529","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":178,"discounted_cash":40.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV-1 HSV-2 PCR 2010095","code_information":[{"code":"87529","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":53,"maximum":81.7,"gross_charge":100,"discounted_cash":22.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-HSV-1 HSV-2 PCR 2010095","code_information":[{"code":"87529","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":100,"discounted_cash":22.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"HHV-6 DNA QUANT","code_information":[{"code":"87533","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":696.42,"maximum":1073.54,"gross_charge":1314,"discounted_cash":300.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":696.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1073.54,"methodology":"fee schedule"}]}]},{"description":"HHV-6 DNA QUANT","code_information":[{"code":"87533","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.05,"maximum":1073.54,"gross_charge":1314,"discounted_cash":300.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":86.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":86.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":122.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":696.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1073.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-HHV 6A 6B QUANT PCR 60071","code_information":[{"code":"87533","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":136.74,"maximum":210.79,"gross_charge":258,"discounted_cash":59.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":210.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-HHV 6A 6B QUANT PCR 60071","code_information":[{"code":"87533","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.05,"maximum":210.79,"gross_charge":258,"discounted_cash":59.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":86.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":86.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":122.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":210.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"}]}]},{"description":"IA HIV1 QN RT","code_information":[{"code":"87536","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":195.04,"maximum":300.66,"gross_charge":368,"discounted_cash":84.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":195.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":300.66,"methodology":"fee schedule"}]}]},{"description":"IA HIV1 QN RT","code_information":[{"code":"87536","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":51.06,"maximum":414.18,"gross_charge":368,"discounted_cash":84.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":414.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":414.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":176.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":176.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":248.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":195.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":300.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":85.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":87.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":86.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 QN NATT RFLX3000870","code_information":[{"code":"87536","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":180.73,"maximum":278.6,"gross_charge":341,"discounted_cash":78.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":180.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":278.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 QN NATT RFLX3000870","code_information":[{"code":"87536","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":51.06,"maximum":414.18,"gross_charge":341,"discounted_cash":78.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":414.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":414.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":176.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":176.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":248.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":180.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":278.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":85.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":87.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":86.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL HIV1 QN NATT P3000867","code_information":[{"code":"87536","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":156.35,"maximum":241.02,"gross_charge":295,"discounted_cash":67.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":156.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":241.02,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFL HIV1 QN NATT P3000867","code_information":[{"code":"87536","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":51.06,"maximum":414.18,"gross_charge":295,"discounted_cash":67.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":414.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":414.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":176.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":176.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":248.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":156.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":241.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":85.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":87.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":86.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA LEGION AMP PRB2010125A","code_information":[{"code":"87541","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":77.38,"maximum":119.29,"gross_charge":146,"discounted_cash":33.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA LEGION AMP PRB2010125A","code_information":[{"code":"87541","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":146,"discounted_cash":33.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA MYCOBACTERIA AMP PROBE TECH","code_information":[{"code":"87551","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":722.39,"maximum":1113.58,"gross_charge":1363,"discounted_cash":312.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":722.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1113.58,"methodology":"fee schedule"}]}]},{"description":"IA MYCOBACTERIA AMP PROBE TECH","code_information":[{"code":"87551","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":28.94,"maximum":1113.58,"gross_charge":1363,"discounted_cash":312.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":100.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":100.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":141.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":722.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1113.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"}]}]},{"description":"IA MYCOBACT TUBERCULOS AMP PRB","code_information":[{"code":"87556","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":310.05,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"}]}]},{"description":"IA MYCOBACT TUBERCULOS AMP PRB","code_information":[{"code":"87556","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":86.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":86.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":121.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"}]}]},{"description":"MYCOBACTERIA AVIUM","code_information":[{"code":"87561","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":358.81,"maximum":553.11,"gross_charge":677,"discounted_cash":155.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":358.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":553.11,"methodology":"fee schedule"}]}]},{"description":"MYCOBACTERIA AVIUM","code_information":[{"code":"87561","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":553.11,"gross_charge":677,"discounted_cash":155.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":358.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":553.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA MYCO GENIT AMP2011172B","code_information":[{"code":"87563","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA MYCO GENIT AMP2011172B","code_information":[{"code":"87563","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOB TB CMPX DET 2010775","code_information":[{"code":"87564","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":86.39,"maximum":133.18,"gross_charge":163,"discounted_cash":37.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.18,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOB TB CMPX DET 2010775","code_information":[{"code":"87564","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":46.06,"maximum":373.6,"gross_charge":163,"discounted_cash":37.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":373.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":373.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":46.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46.06,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOPLASMA PNEUM PCR60256","code_information":[{"code":"87581","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":115.01,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-MYCOPLASMA PNEUM PCR60256","code_information":[{"code":"87581","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA NEISSERIA GONORR AMP PROBE","code_information":[{"code":"87591","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":153.17,"maximum":236.12,"gross_charge":289,"discounted_cash":66.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":153.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":236.12,"methodology":"fee schedule"}]}]},{"description":"IA NEISSERIA GONORR AMP PROBE","code_information":[{"code":"87591","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":236.12,"gross_charge":289,"discounted_cash":66.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":153.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":236.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA NEISSERIA G AMP 60241B","code_information":[{"code":"87591","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":123.49,"maximum":190.37,"gross_charge":233,"discounted_cash":53.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":123.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.37,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA NEISSERIA G AMP 60241B","code_information":[{"code":"87591","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":190.37,"gross_charge":233,"discounted_cash":53.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":123.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-ORTHOPOXVIRUS PCR 3005716","code_information":[{"code":"87593","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":180.2,"maximum":277.78,"gross_charge":340,"discounted_cash":77.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":180.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-ORTHOPOXVIRUS PCR 3005716","code_information":[{"code":"87593","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.55,"maximum":367.23,"gross_charge":340,"discounted_cash":77.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":367.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":367.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":180.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.78,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"minimum":10611.63,"maximum":75093.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68377,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68377,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14148.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10611.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10611.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":66157,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":54556.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":75093.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31660.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31977.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32610.8,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32294.19,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31660.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31660.97,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31660.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32452.5,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31660.97,"methodology":"case rate"}]}]},{"description":"IA RESP VIRUS 3-5 TARGETS","code_information":[{"code":"87631","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":112.89,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"}]}]},{"description":"IA RESP VIRUS 3-5 TARGETS","code_information":[{"code":"87631","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":85.57,"maximum":694.16,"gross_charge":213,"discounted_cash":48.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":694.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":694.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":417.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":144.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":146.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":145.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"}]}]},{"description":"RL-A-RESPIRATORY MINI PCR60764","code_information":[{"code":"87631","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":311.64,"maximum":480.4,"gross_charge":588,"discounted_cash":134.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":311.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-RESPIRATORY MINI PCR60764","code_information":[{"code":"87631","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":85.57,"maximum":694.16,"gross_charge":588,"discounted_cash":134.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":694.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":694.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":417.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":311.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":144.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":146.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":145.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"}]}]},{"description":"VISBY IA RESP VIRUS 3-5 TARGET","code_information":[{"code":"87631","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":327.54,"maximum":504.91,"gross_charge":618,"discounted_cash":141.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":327.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":504.91,"methodology":"fee schedule"}]}]},{"description":"VISBY IA RESP VIRUS 3-5 TARGET","code_information":[{"code":"87631","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":85.57,"maximum":694.16,"gross_charge":618,"discounted_cash":141.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":694.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":694.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":417.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":327.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":504.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":144.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":146.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":145.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":146.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"methodology":"fee schedule"}]}]},{"description":"IA RESP VIRUS 12-25 TARGETS","code_information":[{"code":"87633","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":1027.14,"maximum":1583.35,"gross_charge":1938,"discounted_cash":443.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1027.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1583.35,"methodology":"fee schedule"}]}]},{"description":"IA RESP VIRUS 12-25 TARGETS","code_information":[{"code":"87633","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":250.06,"maximum":2028.37,"gross_charge":1938,"discounted_cash":443.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2028.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2028.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":864.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":864.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1219.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1219.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1027.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1583.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":250.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":420.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":429.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":427.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"methodology":"fee schedule"}]}]},{"description":"IA RSV AMP PROBE QL PCR","code_information":[{"code":"87634","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":165.89,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"}]}]},{"description":"IA RSV AMP PROBE QL PCR","code_information":[{"code":"87634","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":341.68,"gross_charge":313,"discounted_cash":71.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":341.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":341.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":145.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":145.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":205.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":70.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":72.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"}]}]},{"description":"SARS-COV-2 COVID-19 PROB TECH","code_information":[{"code":"87635","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":111.83,"maximum":172.39,"gross_charge":211,"discounted_cash":48.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"}]}]},{"description":"SARS-COV-2 COVID-19 PROB TECH","code_information":[{"code":"87635","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":30.78,"maximum":367.23,"gross_charge":211,"discounted_cash":48.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":367.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":367.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":51.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":52.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":51.31,"methodology":"fee schedule"}]}]},{"description":"IA STREP A AMP PROBE","code_information":[{"code":"87651","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":179.67,"maximum":276.97,"gross_charge":339,"discounted_cash":77.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.97,"methodology":"fee schedule"}]}]},{"description":"IA STREP A AMP PROBE","code_information":[{"code":"87651","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":276.97,"gross_charge":339,"discounted_cash":77.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA TRICHOMONA VAG DIRECT PROBE","code_information":[{"code":"87660","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"IA TRICHOMONA VAG DIRECT PROBE","code_information":[{"code":"87660","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.03,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"}]}]},{"description":"IA TRICHOMONAS VAG AMP PROBE","code_information":[{"code":"87661","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":111.3,"maximum":171.57,"gross_charge":210,"discounted_cash":48.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.57,"methodology":"fee schedule"}]}]},{"description":"IA TRICHOMONAS VAG AMP PROBE","code_information":[{"code":"87661","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":171.57,"gross_charge":210,"discounted_cash":48.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":94.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":94.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-VAGINOS PNL TMA 3002581C","code_information":[{"code":"87661","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":74.2,"maximum":114.38,"gross_charge":140,"discounted_cash":32.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-VAGINOS PNL TMA 3002581C","code_information":[{"code":"87661","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":140,"discounted_cash":32.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":94.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":94.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA NA AMP PROBE NOS","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":108.12,"maximum":166.67,"gross_charge":204,"discounted_cash":46.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"}]}]},{"description":"IA NA AMP PROBE NOS","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":204,"discounted_cash":46.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADENOVIRUS QL PCR 2007473","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":295.74,"maximum":455.89,"gross_charge":558,"discounted_cash":127.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":295.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":455.89,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADENOVIRUS QL PCR 2007473","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":455.89,"gross_charge":558,"discounted_cash":127.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":295.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":455.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORDETELLA PERT PCR 65080","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":246.45,"maximum":379.91,"gross_charge":465,"discounted_cash":106.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":246.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-BORDETELLA PERT PCR 65080","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":379.91,"gross_charge":465,"discounted_cash":106.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":246.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-EPSTEIN BARR PCR 50246","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":93.28,"maximum":143.8,"gross_charge":176,"discounted_cash":40.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-EPSTEIN BARR PCR 50246","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":176,"discounted_cash":40.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA NA AMP PRB NOS 3000352","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":74.2,"maximum":114.38,"gross_charge":140,"discounted_cash":32.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA NA AMP PRB NOS 3000352","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":140,"discounted_cash":32.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA NA AMP PRB NOS2010125B","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA NA AMP PRB NOS2010125B","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA NA AMP PRB NOS2011172A","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA NA AMP PRB NOS2011172A","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-JC VIRUS BY PCR 99169","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":187.62,"maximum":289.22,"gross_charge":354,"discounted_cash":81.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-JC VIRUS BY PCR 99169","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":289.22,"gross_charge":354,"discounted_cash":81.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":187.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-NOROVIRUS 1 2 PCR 2014546","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":232.67,"maximum":358.67,"gross_charge":439,"discounted_cash":100.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":232.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":358.67,"methodology":"fee schedule"}]}]},{"description":"RL-A-NOROVIRUS 1 2 PCR 2014546","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":358.67,"gross_charge":439,"discounted_cash":100.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":232.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":358.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-PARVOVIRUS B19 PCR 60043","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":127.2,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"}]}]},{"description":"RL-A-PARVOVIRUS B19 PCR 60043","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-TROPHER WHIPP PCR 2013290","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":66.25,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-TROPHER WHIPP PCR 2013290","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":170.77,"gross_charge":125,"discounted_cash":28.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE VIRUS PCR 50229","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":291.5,"maximum":449.35,"gross_charge":550,"discounted_cash":125.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":291.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":449.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-WEST NILE VIRUS PCR 50229","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":21.05,"maximum":449.35,"gross_charge":550,"discounted_cash":125.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":291.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":449.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"IA NA NOS DIRECT PROBE QN EA","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":376.83,"maximum":580.89,"gross_charge":711,"discounted_cash":162.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":376.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":580.89,"methodology":"fee schedule"}]}]},{"description":"IA NA NOS DIRECT PROBE QN EA","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":580.89,"gross_charge":711,"discounted_cash":162.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":376.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":580.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADENOVIRUS QN PCR 2007192","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":492.37,"maximum":759,"gross_charge":929,"discounted_cash":212.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":492.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"methodology":"fee schedule"}]}]},{"description":"RL-A-ADENOVIRUS QN PCR 2007192","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":759,"gross_charge":929,"discounted_cash":212.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":492.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-BK VIRUS NAAT PLM 3006076","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":142.04,"maximum":218.96,"gross_charge":268,"discounted_cash":61.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":142.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-BK VIRUS NAAT PLM 3006076","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":218.96,"gross_charge":268,"discounted_cash":61.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":142.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-BK VIRUS NAAT UR 3006075","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":139.92,"maximum":215.69,"gross_charge":264,"discounted_cash":60.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-BK VIRUS NAAT UR 3006075","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":215.69,"gross_charge":264,"discounted_cash":60.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":139.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"RL-A-EPS BARR NAAT PLS 3006079","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":253.34,"maximum":390.53,"gross_charge":478,"discounted_cash":109.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":253.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":390.53,"methodology":"fee schedule"}]}]},{"description":"RL-A-EPS BARR NAAT PLS 3006079","code_information":[{"code":"87799","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":25.7,"maximum":390.53,"gross_charge":478,"discounted_cash":109.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":115.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":253.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":390.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"IA NA AMP PROBE MULTI ORGANISM","code_information":[{"code":"87801","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":489.19,"maximum":754.1,"gross_charge":923,"discounted_cash":211.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":489.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":754.1,"methodology":"fee schedule"}]}]},{"description":"IA NA AMP PROBE MULTI ORGANISM","code_information":[{"code":"87801","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":754.1,"gross_charge":923,"discounted_cash":211.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":341.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":341.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":145.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":145.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":205.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":489.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":754.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":70.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":72.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"}]}]},{"description":"INFLUENZA IA AG OPTIC","code_information":[{"code":"87804","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":62.01,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"}]}]},{"description":"INFLUENZA IA AG OPTIC","code_information":[{"code":"87804","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":9.93,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"}]}]},{"description":"STREPTOCOCCUS A IA AG OPTIC","code_information":[{"code":"87880","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":93.81,"maximum":144.61,"gross_charge":177,"discounted_cash":40.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.61,"methodology":"fee schedule"}]}]},{"description":"STREPTOCOCCUS A IA AG OPTIC","code_information":[{"code":"87880","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":9.91,"maximum":144.61,"gross_charge":177,"discounted_cash":40.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"}]}]},{"description":"NOS IA AG OPTIC","code_information":[{"code":"87899","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":102.82,"maximum":158.5,"gross_charge":194,"discounted_cash":44.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.5,"methodology":"fee schedule"}]}]},{"description":"NOS IA AG OPTIC","code_information":[{"code":"87899","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":9.64,"maximum":158.5,"gross_charge":194,"discounted_cash":44.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-S PNEUMONIAE AG UR 60228","code_information":[{"code":"87899","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-S PNEUMONIAE AG UR 60228","code_information":[{"code":"87899","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":9.64,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA PHENO GENO 3003853A","code_information":[{"code":"87900","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":693.77,"maximum":1069.46,"gross_charge":1309,"discounted_cash":299.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":693.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1069.46,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA PHENO GENO 3003853A","code_information":[{"code":"87900","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":78.21,"maximum":1069.46,"gross_charge":1309,"discounted_cash":299.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":634.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":270.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":270.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":381.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":693.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1069.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":131.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":132.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA PHENO GENO 3004615B","code_information":[{"code":"87900","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":874.5,"maximum":1348.05,"gross_charge":1650,"discounted_cash":377.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":874.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1348.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA PHENO GENO 3004615B","code_information":[{"code":"87900","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":78.21,"maximum":1348.05,"gross_charge":1650,"discounted_cash":377.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":634.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":270.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":270.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":381.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":874.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1348.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":131.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":132.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA PHENO GENO 92399A","code_information":[{"code":"87900","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":244.65,"maximum":377.13,"gross_charge":461.6,"discounted_cash":105.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA PHENO GENO 92399A","code_information":[{"code":"87900","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":78.21,"maximum":634.4,"gross_charge":461.6,"discounted_cash":105.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":634.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":270.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":270.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":381.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":131.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":132.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":133.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 RT IA GENO 3003853B","code_information":[{"code":"87901","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":1387.54,"maximum":2138.91,"gross_charge":2618,"discounted_cash":599.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1387.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2138.91,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 RT IA GENO 3003853B","code_information":[{"code":"87901","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":2138.91,"gross_charge":2618,"discounted_cash":599.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1387.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2138.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 RT IA GENO 92399B","code_information":[{"code":"87901","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":244.65,"maximum":377.13,"gross_charge":461.6,"discounted_cash":105.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 RT IA GENO 92399B","code_information":[{"code":"87901","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":1252.98,"gross_charge":461.6,"discounted_cash":105.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"HEP C RT PROTEASE IA GENOTYPE","code_information":[{"code":"87902","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":728.75,"maximum":1123.38,"gross_charge":1375,"discounted_cash":314.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":728.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1123.38,"methodology":"fee schedule"}]}]},{"description":"HEP C RT PROTEASE IA GENOTYPE","code_information":[{"code":"87902","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":1252.98,"gross_charge":1375,"discounted_cash":314.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":693.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":693.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":728.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1123.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-HCV HR GENO SEQ 2006898","code_information":[{"code":"87902","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":796.59,"maximum":1227.96,"gross_charge":1503,"discounted_cash":344.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":796.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1227.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-HCV HR GENO SEQ 2006898","code_information":[{"code":"87902","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":1252.98,"gross_charge":1503,"discounted_cash":344.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":693.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":693.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":796.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1227.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEP C GENOTYPE SEQ 55593","code_information":[{"code":"87902","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":578.76,"maximum":892.17,"gross_charge":1092,"discounted_cash":250.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":578.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":892.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEP C GENOTYPE SEQ 55593","code_information":[{"code":"87902","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":1252.98,"gross_charge":1092,"discounted_cash":250.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":693.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":693.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":578.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":892.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 IA PHENOTYPE 92399C","code_information":[{"code":"87903","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":244.65,"maximum":377.13,"gross_charge":461.6,"discounted_cash":105.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 IA PHENOTYPE 92399C","code_information":[{"code":"87903","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":244.65,"maximum":2378.2,"gross_charge":461.6,"discounted_cash":105.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2378.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2378.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1013.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1013.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1429.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1429.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":293.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":293.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":461.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":466.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":475.45,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":470.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":461.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":461.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":461.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":473.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":461.6,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV-1 DRUG CUL ADD 92399D","code_information":[{"code":"87904","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":244.65,"maximum":377.13,"gross_charge":461.6,"discounted_cash":105.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV-1 DRUG CUL ADD 92399D","code_information":[{"code":"87904","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":15.64,"maximum":377.13,"gross_charge":461.6,"discounted_cash":105.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 OTH IA GENO3003853C","code_information":[{"code":"87906","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":136.74,"maximum":210.79,"gross_charge":258,"discounted_cash":59.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":210.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-HIV 1 OTH IA GENO3003853C","code_information":[{"code":"87906","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":77.23,"maximum":626.52,"gross_charge":258,"discounted_cash":59.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":266.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":266.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":376.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":210.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":77.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":77.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":130.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":132.6,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":131.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":131.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":128.73,"methodology":"fee schedule"}]}]},{"description":"CMV ANTIVIRAL RESISTANCE SEQ","code_information":[{"code":"87910","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":1455.38,"maximum":2243.49,"gross_charge":2746,"discounted_cash":628.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1455.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2243.49,"methodology":"fee schedule"}]}]},{"description":"CMV ANTIVIRAL RESISTANCE SEQ","code_information":[{"code":"87910","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":2243.49,"gross_charge":2746,"discounted_cash":628.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1455.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2243.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-CMV RESIST SEQ 2004760","code_information":[{"code":"87910","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":545.9,"maximum":841.51,"gross_charge":1030,"discounted_cash":235.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":545.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":841.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-CMV RESIST SEQ 2004760","code_information":[{"code":"87910","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":1252.98,"gross_charge":1030,"discounted_cash":235.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":545.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":841.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA GENO DNA RNA 3004615A","code_information":[{"code":"87910","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":874.5,"maximum":1348.05,"gross_charge":1650,"discounted_cash":377.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":874.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1348.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-IA GENO DNA RNA 3004615A","code_information":[{"code":"87910","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":1348.05,"gross_charge":1650,"discounted_cash":377.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":874.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1348.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEP B SEQUENCING 2001567","code_information":[{"code":"87912","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":772.74,"maximum":1191.19,"gross_charge":1458,"discounted_cash":333.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":772.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1191.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-HEP B SEQUENCING 2001567","code_information":[{"code":"87912","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":154.47,"maximum":1252.98,"gross_charge":1458,"discounted_cash":333.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1252.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":533.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":753.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":772.74,"methodology":"fee schedule"},{"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":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":154.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.03,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"MICROBIOLOGY PROCEDURE","code_information":[{"code":"87999","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":531.06,"maximum":818.64,"gross_charge":1002,"discounted_cash":229.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":818.64,"methodology":"fee schedule"}]}]},{"description":"MICROBIOLOGY PROCEDURE","code_information":[{"code":"87999","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":58.48,"maximum":818.64,"gross_charge":1002,"discounted_cash":229.46,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":818.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.28,"methodology":"fee schedule"}]}]},{"description":"SJP-BIOFIRE JI PCR TEST","code_information":[{"code":"87999","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":395.91,"maximum":610.3,"gross_charge":747,"discounted_cash":171.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":395.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":610.3,"methodology":"fee schedule"}]}]},{"description":"SJP-BIOFIRE JI PCR TEST","code_information":[{"code":"87999","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":58.48,"maximum":610.3,"gross_charge":747,"discounted_cash":171.07,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":395.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":610.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"minimum":8686.17,"maximum":19822.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16096,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16096,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13110.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9832.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9832.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":17328.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12843.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19822.66,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8686.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8773.04,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8946.76,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8859.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8686.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8686.17,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8686.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8903.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8686.17,"methodology":"case rate"}]}]},{"description":"AUTOPSY NECROPSY LIMITED","code_information":[{"code":"88036","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1789.28,"maximum":2758.2,"gross_charge":3376,"discounted_cash":773.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1789.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2758.2,"methodology":"fee schedule"}]}]},{"description":"AUTOPSY NECROPSY LIMITED","code_information":[{"code":"88036","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":9.09,"maximum":2758.2,"gross_charge":3376,"discounted_cash":773.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":490.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":490.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1789.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2758.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":62.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":62.28,"methodology":"fee schedule"}]}]},{"description":"DEPRESSIVE NEUROSES","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"minimum":8342.05,"maximum":16902.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15390,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15390,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13497.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10123.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10123.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14890.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12279.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16902.15,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8342.05,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8425.48,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8592.32,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8508.9,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8342.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8342.05,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8342.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8550.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8342.05,"methodology":"case rate"}]}]},{"description":"CYTOPATH FLUID SMEAR","code_information":[{"code":"88104","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":181.26,"maximum":279.42,"gross_charge":342,"discounted_cash":78.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":181.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":279.42,"methodology":"fee schedule"}]}]},{"description":"CYTOPATH FLUID SMEAR","code_information":[{"code":"88104","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":22.92,"maximum":279.42,"gross_charge":342,"discounted_cash":78.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":118.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":118.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":181.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":279.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"}]}]},{"description":"CYTOPATH CONCENTRATION","code_information":[{"code":"88108","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":145.75,"maximum":224.68,"gross_charge":275,"discounted_cash":62.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":224.68,"methodology":"fee schedule"}]}]},{"description":"CYTOPATH CONCENTRATION","code_information":[{"code":"88108","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":22.92,"maximum":224.68,"gross_charge":275,"discounted_cash":62.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":212.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":159.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":159.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":130.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":145.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":224.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"}]}]},{"description":"CYTOPATH THIN PREP NONGYN","code_information":[{"code":"88112","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":174.37,"maximum":268.8,"gross_charge":329,"discounted_cash":75.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"}]}]},{"description":"CYTOPATH THIN PREP NONGYN","code_information":[{"code":"88112","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":30.97,"maximum":268.8,"gross_charge":329,"discounted_cash":75.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":184.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":94.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":94.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":117.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOP UR 3-5 MAN 2001181","code_information":[{"code":"88120","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":1004.35,"maximum":1548.22,"gross_charge":1895,"discounted_cash":433.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1004.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1548.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOP UR 3-5 MAN 2001181","code_information":[{"code":"88120","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":2648.52,"gross_charge":1895,"discounted_cash":433.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2648.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2648.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1966.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1475.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1475.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1598.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1598.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1004.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1548.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-BLADDER CANC FISH 3016627","code_information":[{"code":"88121","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":351.39,"maximum":541.68,"gross_charge":663,"discounted_cash":151.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":351.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":541.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-BLADDER CANC FISH 3016627","code_information":[{"code":"88121","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":1832.19,"gross_charge":663,"discounted_cash":151.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1832.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1832.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1751.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1313.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1313.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1102.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1102.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":351.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":541.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOP UR 3-5 CMPT 2001181","code_information":[{"code":"88121","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":1004.35,"maximum":1548.22,"gross_charge":1895,"discounted_cash":433.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1004.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1548.22,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOP UR 3-5 CMPT 2001181","code_information":[{"code":"88121","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":1832.19,"gross_charge":1895,"discounted_cash":433.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1832.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1832.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1751.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1313.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1313.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1102.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1102.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1004.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1548.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"CYTOPATH CER/VAG AUTO MAN SCRN","code_information":[{"code":"88142","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":121.37,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"}]}]},{"description":"CYTOPATH CER/VAG AUTO MAN SCRN","code_information":[{"code":"88142","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":12.15,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":56.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":56.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":59.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOPATH THIN 2000137","code_information":[{"code":"88142","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":62.01,"maximum":95.59,"gross_charge":117,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"}]}]},{"description":"RL-A-CYTOPATH THIN 2000137","code_information":[{"code":"88142","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":12.15,"maximum":98.62,"gross_charge":117,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":56.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":56.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":59.27,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"}]}]},{"description":"CYTO SMEAR OTHER PREP SCR INTP","code_information":[{"code":"88161","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":63.07,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"CYTO SMEAR OTHER PREP SCR INTP","code_information":[{"code":"88161","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":17.02,"maximum":228.88,"gross_charge":119,"discounted_cash":27.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":153.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"}]}]},{"description":"CYTO FNA ADEQUACY 1ST EVAL","code_information":[{"code":"88172","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":216.24,"maximum":333.34,"gross_charge":408,"discounted_cash":93.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":216.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.34,"methodology":"fee schedule"}]}]},{"description":"CYTO FNA ADEQUACY 1ST EVAL","code_information":[{"code":"88172","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":51.22,"maximum":333.34,"gross_charge":408,"discounted_cash":93.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":61.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":216.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"CYTO FNA EVAL INTERP REPORT","code_information":[{"code":"88173","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":255.99,"maximum":394.62,"gross_charge":483,"discounted_cash":110.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":255.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.62,"methodology":"fee schedule"}]}]},{"description":"CYTO FNA EVAL INTERP REPORT","code_information":[{"code":"88173","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":30.97,"maximum":412.6,"gross_charge":483,"discounted_cash":110.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":206.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":206.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":275.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":255.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"S/O FNA INTERP/REPORT","code_information":[{"code":"88173","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":284.08,"maximum":437.92,"gross_charge":536,"discounted_cash":122.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":284.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.92,"methodology":"fee schedule"}]}]},{"description":"S/O FNA INTERP/REPORT","code_information":[{"code":"88173","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":30.97,"maximum":437.92,"gross_charge":536,"discounted_cash":122.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":206.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":206.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":275.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":284.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"CYTO THIN PREP AUTO MAN RESCRN","code_information":[{"code":"88175","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":97.52,"maximum":150.33,"gross_charge":184,"discounted_cash":42.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":97.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"}]}]},{"description":"CYTO THIN PREP AUTO MAN RESCRN","code_information":[{"code":"88175","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":15.96,"maximum":150.33,"gross_charge":184,"discounted_cash":42.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":77.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":97.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.88,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.41,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"}]}]},{"description":"CYTO FNA ADEQUACY ADDL EVAL","code_information":[{"code":"88177","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":90.63,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"}]}]},{"description":"CYTO FNA ADEQUACY ADDL EVAL","code_information":[{"code":"88177","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":4.91,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"}]}]},{"description":"FLOW CYTO FIRST MARKER","code_information":[{"code":"88184","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":233.2,"maximum":359.48,"gross_charge":440,"discounted_cash":100.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":233.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":359.48,"methodology":"fee schedule"}]}]},{"description":"FLOW CYTO FIRST MARKER","code_information":[{"code":"88184","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":81.54,"maximum":394.91,"gross_charge":440,"discounted_cash":100.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":244.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":244.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":220.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":233.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":359.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":387.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":394.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":391.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":392.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"}]}]},{"description":"FLOW CYTO EA ADDL MARKER","code_information":[{"code":"88185","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":117.66,"maximum":181.38,"gross_charge":222,"discounted_cash":50.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.38,"methodology":"fee schedule"}]}]},{"description":"FLOW CYTO EA ADDL MARKER","code_information":[{"code":"88185","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":13.95,"maximum":197.66,"gross_charge":222,"discounted_cash":50.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"}]}]},{"description":"NEUROSES EXCEPT DEPRESSIVE","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"minimum":8712.46,"maximum":25722.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14836,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14836,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25722.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19291.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19291.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14354.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11837.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16293.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8712.46,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8799.59,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8973.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8886.71,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8712.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8712.46,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8712.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8930.28,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8712.46,"methodology":"case rate"}]}]},{"description":"RL-A-TISS CULT LYMPH 2005763A","code_information":[{"code":"88230","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-TISS CULT LYMPH 2005763A","code_information":[{"code":"88230","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":69.89,"maximum":566.91,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":566.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":566.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":273.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":273.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":340.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":69.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":69.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":119.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":118.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":119.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULTURE NON NEO LYMPH","code_information":[{"code":"88230","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":474.88,"maximum":732.04,"gross_charge":896,"discounted_cash":205.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULTURE NON NEO LYMPH","code_information":[{"code":"88230","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":69.89,"maximum":732.04,"gross_charge":896,"discounted_cash":205.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":566.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":566.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":273.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":273.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":340.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":732.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":69.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":69.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":119.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":118.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":119.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"methodology":"fee schedule"}]}]},{"description":"RL-A-TIS CULT SKIN/OTH2002288A","code_information":[{"code":"88233","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":477,"maximum":735.3,"gross_charge":900,"discounted_cash":206.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":477,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":735.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-TIS CULT SKIN/OTH2002288A","code_information":[{"code":"88233","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":84.43,"maximum":735.3,"gross_charge":900,"discounted_cash":206.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":684.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":330.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":330.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":477,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":735.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":142.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":144.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":143.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-TIS CULT SKIN/OTH2005762B","code_information":[{"code":"88233","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":298.39,"maximum":459.98,"gross_charge":563,"discounted_cash":128.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":298.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":459.98,"methodology":"fee schedule"}]}]},{"description":"RL-A-TIS CULT SKIN/OTH2005762B","code_information":[{"code":"88233","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":84.43,"maximum":684.92,"gross_charge":563,"discounted_cash":128.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":684.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":330.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":330.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":298.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":459.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":142.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":144.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":143.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULTURE SKIN/OTHER","code_information":[{"code":"88233","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":458.45,"maximum":706.71,"gross_charge":865,"discounted_cash":198.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":458.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":706.71,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULTURE SKIN/OTHER","code_information":[{"code":"88233","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":84.43,"maximum":706.71,"gross_charge":865,"discounted_cash":198.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":684.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":330.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":330.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":411.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":458.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":706.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":84.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":142.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":144.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":143.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":144.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":140.73,"methodology":"fee schedule"}]}]},{"description":"RL-A-TIS CULT AMNI/CVS2002291A","code_information":[{"code":"88235","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":545.9,"maximum":841.51,"gross_charge":1030,"discounted_cash":235.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":545.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":841.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-TIS CULT AMNI/CVS2002291A","code_information":[{"code":"88235","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":90.18,"maximum":841.51,"gross_charge":1030,"discounted_cash":235.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":731.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":731.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":470.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":353.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":353.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":439.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":545.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":841.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":151.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":154.81,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-TIS CULT AMNI/CVS2002293A","code_information":[{"code":"88235","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":263.94,"maximum":406.87,"gross_charge":498,"discounted_cash":114.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":263.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-TIS CULT AMNI/CVS2002293A","code_information":[{"code":"88235","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":90.18,"maximum":731.45,"gross_charge":498,"discounted_cash":114.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":731.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":731.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":470.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":353.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":353.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":439.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":263.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":151.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":154.81,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULTURE AMNIOTIC/CVS","code_information":[{"code":"88235","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":479.65,"maximum":739.39,"gross_charge":905,"discounted_cash":207.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":479.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":739.39,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULTURE AMNIOTIC/CVS","code_information":[{"code":"88235","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":90.18,"maximum":739.39,"gross_charge":905,"discounted_cash":207.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":731.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":731.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":470.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":353.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":353.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":439.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":479.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":739.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":90.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":151.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":154.81,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":154.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":150.3,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULT BONE MAR BLD CELLS","code_information":[{"code":"88237","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":891.46,"maximum":1374.2,"gross_charge":1682,"discounted_cash":385.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":891.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1374.2,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULT BONE MAR BLD CELLS","code_information":[{"code":"88237","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":86.25,"maximum":1374.2,"gross_charge":1682,"discounted_cash":385.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":699.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":450.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":420.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":420.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":891.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1374.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":86.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":86.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":143.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":145.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":148.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":146.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":143.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":143.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":143.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":147.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":143.75,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULTURE SOLID TUMOR","code_information":[{"code":"88239","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":338.67,"maximum":522.07,"gross_charge":639,"discounted_cash":146.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":338.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":522.07,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULTURE SOLID TUMOR","code_information":[{"code":"88239","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":88.51,"maximum":717.92,"gross_charge":639,"discounted_cash":146.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":717.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":717.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":462.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":346.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":346.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":431.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":431.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":338.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":522.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":149,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":151.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":151.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":147.52,"methodology":"fee schedule"}]}]},{"description":"CHROM CNT 15-20CELL 2KARY BAND","code_information":[{"code":"88262","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":598.37,"maximum":922.4,"gross_charge":1129,"discounted_cash":258.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":598.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":922.4,"methodology":"fee schedule"}]}]},{"description":"CHROM CNT 15-20CELL 2KARY BAND","code_information":[{"code":"88262","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":75.29,"maximum":922.4,"gross_charge":1129,"discounted_cash":258.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":294.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":294.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":598.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":922.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":126.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":129.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":128,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM ANAL 15-20 2002288B","code_information":[{"code":"88262","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":477,"maximum":735.3,"gross_charge":900,"discounted_cash":206.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":477,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":735.3,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM ANAL 15-20 2002288B","code_information":[{"code":"88262","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":75.29,"maximum":735.3,"gross_charge":900,"discounted_cash":206.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":294.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":294.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":477,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":735.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":126.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":129.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":128,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM ANAL 15-20 2005763A","code_information":[{"code":"88262","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM ANAL 15-20 2005763A","code_information":[{"code":"88262","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":75.29,"maximum":610.71,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":294.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":294.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":126.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":129.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":128,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM ANLS 15-20 2005762A","code_information":[{"code":"88262","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":266.06,"maximum":410.14,"gross_charge":502,"discounted_cash":114.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM ANLS 15-20 2005762A","code_information":[{"code":"88262","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":75.29,"maximum":610.71,"gross_charge":502,"discounted_cash":114.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":294.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":294.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":367.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":126.75,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":129.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":128,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"methodology":"fee schedule"}]}]},{"description":"CHROM COUNT 45CELL 1 KARY BAND","code_information":[{"code":"88263","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":788.11,"maximum":1214.88,"gross_charge":1487,"discounted_cash":340.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":788.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1214.88,"methodology":"fee schedule"}]}]},{"description":"CHROM COUNT 45CELL 1 KARY BAND","code_information":[{"code":"88263","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":90.17,"maximum":1214.88,"gross_charge":1487,"discounted_cash":340.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":731.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":731.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":470.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":353.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":353.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":439.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":788.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1214.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":150.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":151.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":154.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":153.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":150.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":150.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":150.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":154.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":150.29,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM ANA AF/CV 2002291B","code_information":[{"code":"88267","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":545.9,"maximum":841.51,"gross_charge":1030,"discounted_cash":235.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":545.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":841.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM ANA AF/CV 2002291B","code_information":[{"code":"88267","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":113.14,"maximum":917.74,"gross_charge":1030,"discounted_cash":235.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":917.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":917.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":590.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":443.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":443.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":551.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":551.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":545.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":841.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":113.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":113.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":188.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":190.46,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":194.23,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":192.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":188.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":188.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":188.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":193.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":188.57,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM AMNIO FLD 2002293B","code_information":[{"code":"88269","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":263.94,"maximum":406.87,"gross_charge":498,"discounted_cash":114.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":263.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHROM AMNIO FLD 2002293B","code_information":[{"code":"88269","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":104.19,"maximum":845.17,"gross_charge":498,"discounted_cash":114.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":845.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":845.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":543.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":408.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":408.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":507.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":263.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":104.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":104.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":178,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":178,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":178,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":178.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":177.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":178.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":173.66,"methodology":"fee schedule"}]}]},{"description":"MOLECULAR CYTOGENETC DNA PROBE","code_information":[{"code":"88271","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":137.27,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"}]}]},{"description":"MOLECULAR CYTOGENETC DNA PROBE","code_information":[{"code":"88271","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":12.85,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":62.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-MCG DNA PROBE EA 2002298A","code_information":[{"code":"88271","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":66.25,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-MCG DNA PROBE EA 2002298A","code_information":[{"code":"88271","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":12.85,"maximum":104.28,"gross_charge":125,"discounted_cash":28.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":62.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"}]}]},{"description":"CYTOGEN CHROM IN SITU 10-30","code_information":[{"code":"88273","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":137.27,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"}]}]},{"description":"CYTOGEN CHROM IN SITU 10-30","code_information":[{"code":"88273","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":20.88,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35.16,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34.81,"methodology":"fee schedule"}]}]},{"description":"CYTOG INTERPHASE INSITU100-300","code_information":[{"code":"88275","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":138.33,"maximum":213.24,"gross_charge":261,"discounted_cash":59.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":138.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":213.24,"methodology":"fee schedule"}]}]},{"description":"CYTOG INTERPHASE INSITU100-300","code_information":[{"code":"88275","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":30.71,"maximum":249.14,"gross_charge":261,"discounted_cash":59.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":120.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":120.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":149.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":138.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":213.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":51.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":52.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-MOL CYTO IN SITU 2002298B","code_information":[{"code":"88275","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":66.25,"maximum":102.13,"gross_charge":125,"discounted_cash":28.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"}]}]},{"description":"RL-A-MOL CYTO IN SITU 2002298B","code_information":[{"code":"88275","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":30.71,"maximum":249.14,"gross_charge":125,"discounted_cash":28.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":120.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":120.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":149.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":51.71,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":52.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"}]}]},{"description":"CHROM ANLYS ADDL CELLS COUNT","code_information":[{"code":"88285","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":273.48,"maximum":421.58,"gross_charge":516,"discounted_cash":118.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":273.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":421.58,"methodology":"fee schedule"}]}]},{"description":"CHROM ANLYS ADDL CELLS COUNT","code_information":[{"code":"88285","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":16.14,"maximum":421.58,"gross_charge":516,"discounted_cash":118.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":130.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":63.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":63.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":78.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":273.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":421.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"}]}]},{"description":"CHROM ANLYS ADDL HIGH RESOLUT","code_information":[{"code":"88289","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":218.36,"maximum":336.61,"gross_charge":412,"discounted_cash":94.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":336.61,"methodology":"fee schedule"}]}]},{"description":"CHROM ANLYS ADDL HIGH RESOLUT","code_information":[{"code":"88289","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":20.65,"maximum":336.61,"gross_charge":412,"discounted_cash":94.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":80.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":80.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":100.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":336.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":34.78,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"minimum":15609.54,"maximum":27574.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25108,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25108,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23624.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":17718.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":17718.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24292.7,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20032.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27574.05,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15609.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15765.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16077.83,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15921.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15609.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15609.54,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15609.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15999.78,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15609.54,"methodology":"case rate"}]}]},{"description":"GROSS ONLY LEVEL I","code_information":[{"code":"88300","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":245.92,"maximum":379.09,"gross_charge":464,"discounted_cash":106.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.09,"methodology":"fee schedule"}]}]},{"description":"GROSS ONLY LEVEL I","code_information":[{"code":"88300","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":17.02,"maximum":379.09,"gross_charge":464,"discounted_cash":106.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":34.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL II","code_information":[{"code":"88302","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":285.67,"maximum":440.37,"gross_charge":539,"discounted_cash":123.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":285.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":440.37,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL II","code_information":[{"code":"88302","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":17.02,"maximum":440.37,"gross_charge":539,"discounted_cash":123.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":77.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":285.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":440.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL III","code_information":[{"code":"88304","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":396.44,"maximum":611.12,"gross_charge":748,"discounted_cash":171.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":396.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":611.12,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL III","code_information":[{"code":"88304","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":30.97,"maximum":611.12,"gross_charge":748,"discounted_cash":171.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":93.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":396.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":611.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL IV","code_information":[{"code":"88305","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":669.92,"maximum":1032.69,"gross_charge":1264,"discounted_cash":289.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":669.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1032.69,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL IV","code_information":[{"code":"88305","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":30.97,"maximum":1032.69,"gross_charge":1264,"discounted_cash":289.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":669.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1032.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"S/O GROSS/MICRO LEVEL 4","code_information":[{"code":"88305","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":2225.47,"maximum":3430.59,"gross_charge":4199,"discounted_cash":961.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2225.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3430.59,"methodology":"fee schedule"}]}]},{"description":"S/O GROSS/MICRO LEVEL 4","code_information":[{"code":"88305","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":30.97,"maximum":3430.59,"gross_charge":4199,"discounted_cash":961.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":88.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":88.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2225.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3430.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL V","code_information":[{"code":"88307","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":832.63,"maximum":1283.51,"gross_charge":1571,"discounted_cash":359.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":832.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1283.51,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL V","code_information":[{"code":"88307","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":205.48,"maximum":1283.51,"gross_charge":1571,"discounted_cash":359.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":767.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":575.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":575.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":619.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":619.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":832.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1283.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":387.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":394.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":391.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":392.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL VI","code_information":[{"code":"88309","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":994.81,"maximum":1533.51,"gross_charge":1877,"discounted_cash":429.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":994.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1533.51,"methodology":"fee schedule"}]}]},{"description":"GROSS MICRO LEVEL VI","code_information":[{"code":"88309","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":454.53,"maximum":1533.51,"gross_charge":1877,"discounted_cash":429.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1373.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1373.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1088.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":816.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":816.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":875.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":875.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":994.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1533.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":896.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":888.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":892.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"}]}]},{"description":"DECALCIFICATION PROCEDURE","code_information":[{"code":"88311","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":86.39,"maximum":133.18,"gross_charge":163,"discounted_cash":37.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.18,"methodology":"fee schedule"}]}]},{"description":"DECALCIFICATION PROCEDURE","code_information":[{"code":"88311","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":5.1,"maximum":133.18,"gross_charge":163,"discounted_cash":37.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"}]}]},{"description":"SPECIAL STAIN GROUP I","code_information":[{"code":"88312","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":292.49,"gross_charge":358,"discounted_cash":81.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.49,"methodology":"fee schedule"}]}]},{"description":"SPECIAL STAIN GROUP I","code_information":[{"code":"88312","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":30.97,"maximum":408.24,"gross_charge":358,"discounted_cash":81.99,"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|PPO","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":181.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":181.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":255.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"RL-M-AMYLOID PRO ID PAR","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"}]}]},{"description":"RL-M-AMYLOID PRO ID PAR","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":34.96,"maximum":325,"gross_charge":200,"discounted_cash":45.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":207.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"RL-M-SPCSTIN GRP II OTHER","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":125.61,"maximum":193.63,"gross_charge":237,"discounted_cash":54.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.63,"methodology":"fee schedule"}]}]},{"description":"RL-M-SPCSTIN GRP II OTHER","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":34.96,"maximum":325,"gross_charge":237,"discounted_cash":54.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":207.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"S/O SPECIAL STAIN GRP II","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":168.01,"maximum":258.99,"gross_charge":317,"discounted_cash":72.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":168.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.99,"methodology":"fee schedule"}]}]},{"description":"S/O SPECIAL STAIN GRP II","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":34.96,"maximum":325,"gross_charge":317,"discounted_cash":72.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":207.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":168.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"SPECIAL STAIN GROUP II","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":189.74,"maximum":292.49,"gross_charge":358,"discounted_cash":81.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.49,"methodology":"fee schedule"}]}]},{"description":"SPECIAL STAIN GROUP II","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":34.96,"maximum":325,"gross_charge":358,"discounted_cash":81.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":144.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":207.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"HISTOCHEMICAL STAIN","code_information":[{"code":"88314","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":120.84,"maximum":186.28,"gross_charge":228,"discounted_cash":52.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":186.28,"methodology":"fee schedule"}]}]},{"description":"HISTOCHEMICAL STAIN","code_information":[{"code":"88314","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":40.66,"maximum":366.65,"gross_charge":228,"discounted_cash":52.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":135.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":135.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":208.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":186.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.98,"methodology":"fee schedule"}]}]},{"description":"SPECIAL GROUP STAIN III ENZYME","code_information":[{"code":"88319","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":323.3,"maximum":498.37,"gross_charge":610,"discounted_cash":139.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":323.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":498.37,"methodology":"fee schedule"}]}]},{"description":"SPECIAL GROUP STAIN III ENZYME","code_information":[{"code":"88319","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":143.4,"maximum":628.3,"gross_charge":610,"discounted_cash":139.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":533.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":533.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":157.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":157.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":323.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":323.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":323.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":498.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":610,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":616.1,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":628.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":622.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":610,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":610,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":610,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":625.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":610,"methodology":"fee schedule"}]}]},{"description":"CONSULT PATH REFERRED SLIDE","code_information":[{"code":"88321","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":222.07,"maximum":342.33,"gross_charge":419,"discounted_cash":95.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":222.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":342.33,"methodology":"fee schedule"}]}]},{"description":"CONSULT PATH REFERRED SLIDE","code_information":[{"code":"88321","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":22.92,"maximum":401.22,"gross_charge":419,"discounted_cash":95.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":401.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":401.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":247.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":247.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":242.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":222.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":342.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":42.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"}]}]},{"description":"CONSULT PATH REQUIRING PREP","code_information":[{"code":"88323","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":345.03,"maximum":531.87,"gross_charge":651,"discounted_cash":149.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":345.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":531.87,"methodology":"fee schedule"}]}]},{"description":"CONSULT PATH REQUIRING PREP","code_information":[{"code":"88323","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":30.97,"maximum":531.87,"gross_charge":651,"discounted_cash":149.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":164.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":164.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":83.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":345.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":531.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"fee schedule"}]}]},{"description":"CONSULT PATH COMP REVW REPORT","code_information":[{"code":"88325","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":484.95,"maximum":747.56,"gross_charge":915,"discounted_cash":209.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":484.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":747.56,"methodology":"fee schedule"}]}]},{"description":"CONSULT PATH COMP REVW REPORT","code_information":[{"code":"88325","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":747.56,"gross_charge":915,"discounted_cash":209.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":649.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":519.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":389.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":389.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":388.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":388.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":484.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":747.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"CONSULT PATH DURING SURGERY","code_information":[{"code":"88329","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":83.21,"maximum":128.27,"gross_charge":157,"discounted_cash":35.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.27,"methodology":"fee schedule"}]}]},{"description":"CONSULT PATH DURING SURGERY","code_information":[{"code":"88329","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":34.96,"maximum":169.84,"gross_charge":157,"discounted_cash":35.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":105.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":105.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"FROZEN SECTION FIRST BLOCK","code_information":[{"code":"88331","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":347.68,"maximum":535.96,"gross_charge":656,"discounted_cash":150.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":347.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":535.96,"methodology":"fee schedule"}]}]},{"description":"FROZEN SECTION FIRST BLOCK","code_information":[{"code":"88331","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":535.96,"gross_charge":656,"discounted_cash":150.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":192.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":100.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":100.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":121.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":347.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":535.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"FROZEN SECT EA ADDL TISSUE","code_information":[{"code":"88332","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":122.43,"maximum":188.73,"gross_charge":231,"discounted_cash":52.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":122.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"}]}]},{"description":"FROZEN SECT EA ADDL TISSUE","code_information":[{"code":"88332","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":14.73,"maximum":188.73,"gross_charge":231,"discounted_cash":52.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":73.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":122.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"}]}]},{"description":"INTRAOP CYTO PATH CNSLT INITAL","code_information":[{"code":"88333","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":886.16,"maximum":1366.03,"gross_charge":1672,"discounted_cash":382.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":886.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1366.03,"methodology":"fee schedule"}]}]},{"description":"INTRAOP CYTO PATH CNSLT INITAL","code_information":[{"code":"88333","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":95.18,"maximum":1366.03,"gross_charge":1672,"discounted_cash":382.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":95.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":886.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1366.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":896.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":888.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":892.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"}]}]},{"description":"INTRAOP CYTO PATH CNSLT ADDL","code_information":[{"code":"88334","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":112.89,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"}]}]},{"description":"INTRAOP CYTO PATH CNSLT ADDL","code_information":[{"code":"88334","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":11.39,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"}]}]},{"description":"IMMUNOHIST SINGLE STAIN EA ADD","code_information":[{"code":"88341","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":264.47,"maximum":407.69,"gross_charge":499,"discounted_cash":114.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":264.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":407.69,"methodology":"fee schedule"}]}]},{"description":"IMMUNOHIST SINGLE STAIN EA ADD","code_information":[{"code":"88341","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":37.52,"maximum":407.69,"gross_charge":499,"discounted_cash":114.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":118.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":118.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":173.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":264.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":407.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":37.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"}]}]},{"description":"IMMUNOHIS SINGLE STAIN INITIAL","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":356.69,"maximum":549.85,"gross_charge":673,"discounted_cash":154.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":356.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":549.85,"methodology":"fee schedule"}]}]},{"description":"IMMUNOHIS SINGLE STAIN INITIAL","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":549.85,"gross_charge":673,"discounted_cash":154.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":356.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":549.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALK1 BY IHC 2003439","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":141.51,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALK1 BY IHC 2003439","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":313.76,"gross_charge":267,"discounted_cash":61.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-TREP PALLIDUM IHC 3001704","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":142.04,"maximum":218.96,"gross_charge":268,"discounted_cash":61.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":142.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-TREP PALLIDUM IHC 3001704","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":313.76,"gross_charge":268,"discounted_cash":61.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":142.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"SJP-IHC INITIAL SNGL AB","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"SJP-IHC INITIAL SNGL AB","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":195.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"IMMUNOHIST MULTIPLEX STAIN EA","code_information":[{"code":"88344","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":459.51,"maximum":708.34,"gross_charge":867,"discounted_cash":198.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":459.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":708.34,"methodology":"fee schedule"}]}]},{"description":"IMMUNOHIST MULTIPLEX STAIN EA","code_information":[{"code":"88344","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":181.67,"maximum":708.34,"gross_charge":867,"discounted_cash":198.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":624.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":624.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":200.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":200.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":386.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":459.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":708.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":387.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":394.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":391.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":392.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFLUOR PER SPEC INITIAL","code_information":[{"code":"88346","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":417.64,"maximum":643.8,"gross_charge":788,"discounted_cash":180.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":643.8,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFLUOR PER SPEC INITIAL","code_information":[{"code":"88346","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":643.8,"gross_charge":788,"discounted_cash":180.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":554.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":554.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":173.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":173.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":345.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":643.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"ELECTRON MICROSCOPY DIAGNOSTIC","code_information":[{"code":"88348","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":1525.87,"maximum":2352.15,"gross_charge":2879,"discounted_cash":659.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1525.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2352.15,"methodology":"fee schedule"}]}]},{"description":"ELECTRON MICROSCOPY DIAGNOSTIC","code_information":[{"code":"88348","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":345.15,"maximum":2352.15,"gross_charge":2879,"discounted_cash":659.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1784.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1784.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":460.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":345.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":345.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1175.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1175.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1525.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2352.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":879.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":896.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":888.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":892.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":870.67,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFLUOR PER SPEC EA ADD","code_information":[{"code":"88350","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":84.8,"maximum":130.72,"gross_charge":160,"discounted_cash":36.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFLUOR PER SPEC EA ADD","code_information":[{"code":"88350","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":50.68,"maximum":421.12,"gross_charge":160,"discounted_cash":36.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":113.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":113.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":260.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-ERBB2 IMMUNOH RFLX 49178","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":302.1,"maximum":465.69,"gross_charge":570,"discounted_cash":130.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-ERBB2 IMMUNOH RFLX 49178","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":465.69,"gross_charge":570,"discounted_cash":130.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-PDL1 22C3 BY IHC 3017615","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":368.88,"maximum":568.64,"gross_charge":696,"discounted_cash":159.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":368.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":568.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-PDL1 22C3 BY IHC 3017615","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":568.64,"gross_charge":696,"discounted_cash":159.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":368.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":568.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX ERBB2 IMMUNOH 49174","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":306.87,"maximum":473.05,"gross_charge":579,"discounted_cash":132.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":306.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":473.05,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX ERBB2 IMMUNOH 49174","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":473.05,"gross_charge":579,"discounted_cash":132.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":306.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":473.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX PDL1 22C3 TPS3017680","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":548.02,"maximum":844.78,"gross_charge":1034,"discounted_cash":236.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":548.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":844.78,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX PDL1 22C3 TPS3017680","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":844.78,"gross_charge":1034,"discounted_cash":236.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":548.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":844.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"TUMOR IMMUNOHIST SNG STAIN MAN","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":331.25,"maximum":510.63,"gross_charge":625,"discounted_cash":143.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":331.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":510.63,"methodology":"fee schedule"}]}]},{"description":"TUMOR IMMUNOHIST SNG STAIN MAN","code_information":[{"code":"88360","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":510.63,"gross_charge":625,"discounted_cash":143.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":209.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":331.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":510.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"TUMOR IMMUN SNG STAIN COMPUTER","code_information":[{"code":"88361","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":162.18,"maximum":250.01,"gross_charge":306,"discounted_cash":70.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":162.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.01,"methodology":"fee schedule"}]}]},{"description":"TUMOR IMMUN SNG STAIN COMPUTER","code_information":[{"code":"88361","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":125.52,"maximum":379.26,"gross_charge":306,"discounted_cash":70.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":363.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":363.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":284.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":284.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":223.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":162.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":309.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":315.18,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":312.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":313.65,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"}]}]},{"description":"NERVE TEASING PREPARATIONS","code_information":[{"code":"88362","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":460.57,"maximum":709.98,"gross_charge":869,"discounted_cash":199.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":460.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":709.98,"methodology":"fee schedule"}]}]},{"description":"NERVE TEASING PREPARATIONS","code_information":[{"code":"88362","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":241.03,"maximum":895.07,"gross_charge":869,"discounted_cash":199.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":523.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":523.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":637.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":478.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":478.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":355.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":460.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":709.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":491.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":869,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":877.69,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":895.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":886.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":869,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":869,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":869,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":890.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":869,"methodology":"fee schedule"}]}]},{"description":"TISS EXAM ARCHIVAL MOLC ANALYS","code_information":[{"code":"88363","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":64.66,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"}]}]},{"description":"TISS EXAM ARCHIVAL MOLC ANALYS","code_information":[{"code":"88363","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":17.02,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":51.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":51.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"}]}]},{"description":"IN SITU HYBRID SNG STN EA ADD","code_information":[{"code":"88364","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":319.06,"maximum":491.84,"gross_charge":602,"discounted_cash":137.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":319.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":491.84,"methodology":"fee schedule"}]}]},{"description":"IN SITU HYBRID SNG STN EA ADD","code_information":[{"code":"88364","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":59.33,"maximum":491.84,"gross_charge":602,"discounted_cash":137.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":489.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":489.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":182.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":182.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":305.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":305.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":319.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":491.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":59.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":59.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.19,"methodology":"fee schedule"}]}]},{"description":"IN SITU HYBRID SNG STAIN INIT","code_information":[{"code":"88365","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":236.38,"maximum":364.39,"gross_charge":446,"discounted_cash":102.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.39,"methodology":"fee schedule"}]}]},{"description":"IN SITU HYBRID SNG STAIN INIT","code_information":[{"code":"88365","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":643.56,"gross_charge":446,"discounted_cash":102.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":643.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":292.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":292.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":409.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":409.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-HPV HI RSK HYBRID 3002008","code_information":[{"code":"88365","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-HPV HI RSK HYBRID 3002008","code_information":[{"code":"88365","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":643.56,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":643.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":292.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":292.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":409.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":409.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALK GEN FISH LUNG 3001302","code_information":[{"code":"88366","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":1037.74,"maximum":1599.69,"gross_charge":1958,"discounted_cash":448.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1037.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1599.69,"methodology":"fee schedule"}]}]},{"description":"RL-A-ALK GEN FISH LUNG 3001302","code_information":[{"code":"88366","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":1599.69,"gross_charge":1958,"discounted_cash":448.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1053.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1053.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":224.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":224.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":645.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":645.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1037.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1599.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-ROS1 FISH 3001308","code_information":[{"code":"88366","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":359.87,"maximum":554.75,"gross_charge":679,"discounted_cash":155.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":359.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.75,"methodology":"fee schedule"}]}]},{"description":"RL-A-ROS1 FISH 3001308","code_information":[{"code":"88366","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":1053.58,"gross_charge":679,"discounted_cash":155.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1053.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1053.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":224.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":224.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":645.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":645.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":359.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"INSITU HYBRID CMPT SNG STN INI","code_information":[{"code":"88367","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":319.06,"maximum":491.84,"gross_charge":602,"discounted_cash":137.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":319.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":491.84,"methodology":"fee schedule"}]}]},{"description":"INSITU HYBRID CMPT SNG STN INI","code_information":[{"code":"88367","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":117.3,"maximum":491.84,"gross_charge":602,"discounted_cash":137.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":187.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":187.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":239.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":239.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":319.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":491.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":387.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":394.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":391.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":392.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"}]}]},{"description":"INSITU HYBRID MAN SNG STN INIT","code_information":[{"code":"88368","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":570.28,"maximum":879.1,"gross_charge":1076,"discounted_cash":246.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":570.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":879.1,"methodology":"fee schedule"}]}]},{"description":"INSITU HYBRID MAN SNG STN INIT","code_information":[{"code":"88368","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":155.56,"maximum":879.1,"gross_charge":1076,"discounted_cash":246.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":448.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":448.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":176.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":176.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":300.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":300.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":570.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":879.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":205.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":387.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":394.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":391.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":392.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":383.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-ERRB2 FISH TISSUE 2008603","code_information":[{"code":"88377","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":368.88,"maximum":568.64,"gross_charge":696,"discounted_cash":159.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":368.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":568.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-ERRB2 FISH TISSUE 2008603","code_information":[{"code":"88377","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":1610.97,"gross_charge":696,"discounted_cash":159.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1610.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1610.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":517.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":388.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":388.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":987.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":987.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":368.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":568.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX HER2 RAI1 3001127","code_information":[{"code":"88377","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":322.77,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX HER2 RAI1 3001127","code_information":[{"code":"88377","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":97.64,"maximum":1610.97,"gross_charge":609,"discounted_cash":139.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1610.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1610.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":517.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":388.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":388.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":987.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":987.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.48,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":184.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.21,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":182.64,"methodology":"fee schedule"}]}]},{"description":"RL- M-MICRODISCTION LASER","code_information":[{"code":"88380","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":556.5,"maximum":857.85,"gross_charge":1050,"discounted_cash":240.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":556.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":857.85,"methodology":"fee schedule"}]}]},{"description":"RL- M-MICRODISCTION LASER","code_information":[{"code":"88380","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":43.41,"maximum":857.85,"gross_charge":1050,"discounted_cash":240.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":345.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":165.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":165.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":210.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":556.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":857.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":43.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.89,"methodology":"fee schedule"}]}]},{"description":"TISSUE EXAM MOLECULAR STUDY","code_information":[{"code":"88387","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":31.87,"gross_charge":39,"discounted_cash":8.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"}]}]},{"description":"TISSUE EXAM MOLECULAR STUDY","code_information":[{"code":"88387","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":4.32,"maximum":36.72,"gross_charge":39,"discounted_cash":8.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"}]}]},{"description":"TISSUE EXAM MOLECULAR ADD ON","code_information":[{"code":"88388","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"TISSUE EXAM MOLECULAR ADD ON","code_information":[{"code":"88388","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":9.54,"maximum":40.64,"gross_charge":18,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"}]}]},{"description":"ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"minimum":14188.99,"maximum":29665.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27012,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27012,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20177.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15133.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15133.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26135.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21552.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29665.94,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14188.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14330.88,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14614.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14472.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14188.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14188.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14188.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14543.72,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14188.99,"methodology":"case rate"}]}]},{"description":"PSYCHOSES","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"minimum":12173.76,"maximum":25073.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22831,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22831,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20018.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15014.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15014.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":22089.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":18216.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25073.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12173.76,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12295.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12538.98,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12417.24,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12173.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12173.76,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12173.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12478.11,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12173.76,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL AND DEVELOPMENTAL DISORDERS","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"minimum":13306.07,"maximum":27759.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25277,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25277,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17741.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13306.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13306.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24456.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20167.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27759.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15165.67,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15317.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15620.65,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15468.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15165.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15165.67,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15165.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15544.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15165.67,"methodology":"case rate"}]}]},{"description":"OTHER MENTAL DISORDER DIAGNOSES","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"minimum":6756.87,"maximum":22447.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20439,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20439,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9008.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6756.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6756.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19776.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16308.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22447.5,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10470.95,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10575.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10785.08,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10680.37,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10470.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10470.95,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10470.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10732.73,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10470.95,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS","code_information":[{"code":"8901","type":"APR-DRG"}],"standard_charges":[{"minimum":5601,"maximum":5601,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5601,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5601,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5601,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS","code_information":[{"code":"8902","type":"APR-DRG"}],"standard_charges":[{"minimum":6055,"maximum":6055,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6055,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6055,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6055,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS","code_information":[{"code":"8903","type":"APR-DRG"}],"standard_charges":[{"minimum":10136,"maximum":10136,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10136,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10136,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10136,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS","code_information":[{"code":"8904","type":"APR-DRG"}],"standard_charges":[{"minimum":20803,"maximum":20803,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20803,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20803,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20803,"methodology":"case rate"}]}]},{"description":"CELL COUNT BODY FLUID","code_information":[{"code":"89050","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":109.71,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"}]}]},{"description":"CELL COUNT BODY FLUID","code_information":[{"code":"89050","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":2.83,"maximum":169.12,"gross_charge":207,"discounted_cash":47.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"}]}]},{"description":"CELL COUNT CSF W DIFF","code_information":[{"code":"89051","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":236.38,"maximum":364.39,"gross_charge":446,"discounted_cash":102.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.39,"methodology":"fee schedule"}]}]},{"description":"CELL COUNT CSF W DIFF","code_information":[{"code":"89051","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":364.39,"gross_charge":446,"discounted_cash":102.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":236.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":364.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"CRYSTAL ID LIGHT MICROSCOPY","code_information":[{"code":"89060","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":93.81,"maximum":144.61,"gross_charge":177,"discounted_cash":40.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.61,"methodology":"fee schedule"}]}]},{"description":"CRYSTAL ID LIGHT MICROSCOPY","code_information":[{"code":"89060","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":4.39,"maximum":144.61,"gross_charge":177,"discounted_cash":40.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":93.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"}]}]},{"description":"SMEAR NASAL EOSINOPHILS","code_information":[{"code":"89190","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":53,"maximum":81.7,"gross_charge":100,"discounted_cash":22.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.7,"methodology":"fee schedule"}]}]},{"description":"SMEAR NASAL EOSINOPHILS","code_information":[{"code":"89190","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":3.47,"maximum":81.7,"gross_charge":100,"discounted_cash":22.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"}]}]},{"description":"HIV WITH MAJOR HIV RELATED CONDITION","code_information":[{"code":"8921","type":"APR-DRG"}],"standard_charges":[{"minimum":4056,"maximum":4056,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4056,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4056,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4056,"methodology":"case rate"}]}]},{"description":"HIV WITH MAJOR HIV RELATED CONDITION","code_information":[{"code":"8922","type":"APR-DRG"}],"standard_charges":[{"minimum":5144,"maximum":5144,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5144,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5144,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5144,"methodology":"case rate"}]}]},{"description":"HIV WITH MAJOR HIV RELATED CONDITION","code_information":[{"code":"8923","type":"APR-DRG"}],"standard_charges":[{"minimum":7627,"maximum":7627,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7627,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7627,"methodology":"case rate"}]}]},{"description":"HIV WITH MAJOR HIV RELATED CONDITION","code_information":[{"code":"8924","type":"APR-DRG"}],"standard_charges":[{"minimum":13199,"maximum":13199,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13199,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13199,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13199,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS","code_information":[{"code":"8931","type":"APR-DRG"}],"standard_charges":[{"minimum":3879,"maximum":3879,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3879,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3879,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3879,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS","code_information":[{"code":"8932","type":"APR-DRG"}],"standard_charges":[{"minimum":5594,"maximum":5594,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5594,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5594,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5594,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS","code_information":[{"code":"8933","type":"APR-DRG"}],"standard_charges":[{"minimum":8305,"maximum":8305,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8305,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8305,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS","code_information":[{"code":"8934","type":"APR-DRG"}],"standard_charges":[{"minimum":12339,"maximum":12339,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12339,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12339,"methodology":"case rate"}]}]},{"description":"ALCOHOL DRUG ABUSE OR DEPENDENCE LEFT AMA","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"minimum":6099.48,"maximum":26075.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10902,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10902,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26075.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":19556.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":19556.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10548.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8699.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11973.65,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6099.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6160.48,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6282.47,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6221.47,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6099.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6099.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6099.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6251.97,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6099.48,"methodology":"case rate"}]}]},{"description":"HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS","code_information":[{"code":"8941","type":"APR-DRG"}],"standard_charges":[{"minimum":3784,"maximum":3784,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3784,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3784,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3784,"methodology":"case rate"}]}]},{"description":"HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS","code_information":[{"code":"8942","type":"APR-DRG"}],"standard_charges":[{"minimum":4806,"maximum":4806,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4806,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4806,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4806,"methodology":"case rate"}]}]},{"description":"HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS","code_information":[{"code":"8943","type":"APR-DRG"}],"standard_charges":[{"minimum":6500,"maximum":6500,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6500,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6500,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6500,"methodology":"case rate"}]}]},{"description":"HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS","code_information":[{"code":"8944","type":"APR-DRG"}],"standard_charges":[{"minimum":9878,"maximum":9878,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9878,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9878,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9878,"methodology":"case rate"}]}]},{"description":"ALCOHOL DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"minimum":12469.94,"maximum":33562.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30561,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30561,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29197,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21898.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21898.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29568.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24383.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33562.94,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12469.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12594.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12844.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12719.34,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12469.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12469.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12469.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12781.69,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12469.94,"methodology":"case rate"}]}]},{"description":"ALCOHOL DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"minimum":10144.39,"maximum":35477.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32304,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32304,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13525.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10144.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10144.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31255.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25774.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35477.41,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15044.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15194.71,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15495.59,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15345.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15044.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15044.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15044.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15420.37,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15044.26,"methodology":"case rate"}]}]},{"description":"ALCOHOL DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"minimum":8095.37,"maximum":56791.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15437,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15437,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56791.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":42594.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":42594.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14936.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12317.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16953.73,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8095.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8176.33,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8338.24,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8257.28,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8095.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8095.37,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8095.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8297.76,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8095.37,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENTS FOR INJURIES WITH MCC","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"minimum":27780.25,"maximum":89270.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81286,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81286,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37039.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27780.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27780.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":78646.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":64856.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":89270.13,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35534.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35889.79,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36600.48,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":36245.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35534.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35534.44,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35534.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36422.81,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35534.44,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL HLTH TRXMNT /SERVICES - MILIEU THERAPY","code_information":[{"code":"902","type":"RC"}],"standard_charges":[{"minimum":26.69,"maximum":35.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"WOUND DEBRIDEMENTS FOR INJURIES WITH CC","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"minimum":15947.48,"maximum":40577.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36948,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36948,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29785.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22339.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22339.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35748.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":29479.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40577.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16106.96,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16425.91,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16266.43,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16346.17,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15947.48,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"minimum":10700.62,"maximum":47924.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21490,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21490,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47924.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35944.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35944.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20792.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17146.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23600.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10700.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10807.63,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11021.64,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10914.64,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10700.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10700.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10700.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10968.14,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10700.62,"methodology":"case rate"}]}]},{"description":"RABIES IG 300IU/ML 5ML SDVJW","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"90375","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0318-05","type":"NDC"}],"standard_charges":[{"minimum":7214.89,"maximum":11121.83,"gross_charge":13613,"discounted_cash":3117.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7214.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11121.83,"methodology":"fee schedule"}]}]},{"description":"RABIES IG 300IU/ML 5ML SDVJW","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"90375","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0318-05","type":"NDC"}],"standard_charges":[{"minimum":237.78,"maximum":11121.83,"gross_charge":13613,"discounted_cash":3117.38,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1248.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":936.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":936.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":657.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":657.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7214.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11121.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":283.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":286.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":292.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":289.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":283.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":283.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":283.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":291.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":283.97,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFTS FOR INJURIES WITH CC/MCC","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"minimum":22676.91,"maximum":72976.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66450,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66450,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30235.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22676.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22676.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":64292.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":53018.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":72976.56,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31131.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31442.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32065.2,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31753.89,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31131.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31131.26,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31131.26,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31909.55,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31131.26,"methodology":"case rate"}]}]},{"description":"ADMIN OTHER IMMUN VAC ONE","code_information":[{"code":"90471","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"}]}]},{"description":"ADMIN OTHER IMMUN VAC ONE","code_information":[{"code":"90471","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":23.1,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":76.61,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":78.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":77.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":77.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"}]}]},{"description":"ADMIN OTHER IMMUN VAC ADD","code_information":[{"code":"90472","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"}]}]},{"description":"ADMIN OTHER IMMUN VAC ADD","code_information":[{"code":"90472","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":12.82,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"}]}]},{"description":"ADMIN SARSCOV2 VACCINE","code_information":[{"code":"90480","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":83.74,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"}]}]},{"description":"ADMIN SARSCOV2 VACCINE","code_information":[{"code":"90480","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":39.53,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"minimum":14018.86,"maximum":34336.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31265,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31265,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22261.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16696.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16696.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30250.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24946.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34336.57,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14018.86,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14159.05,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14439.43,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14299.24,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14018.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14018.86,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14018.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14369.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14018.86,"methodology":"case rate"}]}]},{"description":"HAND PROCEDURES FOR INJURIES","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"minimum":18150.61,"maximum":61353.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32702,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32702,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61353.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46015.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46015.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31640.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":26092.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35914.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18150.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18332.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18695.13,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18513.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18150.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18150.61,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18150.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18604.38,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18150.61,"methodology":"case rate"}]}]},{"description":"FLU VACC PF TR SV 0.5ML PFS","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90656","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0884-52","type":"NDC"}],"standard_charges":[{"minimum":58,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":59.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":59.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"}]}]},{"description":"FLU VACC PF TR SV 0.5ML PFS","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90656","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0884-52","type":"NDC"}],"standard_charges":[{"minimum":20.05,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":59.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":59.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"}]}]},{"description":"RABIES VACC 2.5IU/ML 1ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"90675","type":"CPT"},{"code":"0636","type":"RC"},{"code":"50632-0010-01","type":"NDC"}],"standard_charges":[{"minimum":2049.51,"maximum":3159.34,"gross_charge":3867,"discounted_cash":885.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2049.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3159.34,"methodology":"fee schedule"}]}]},{"description":"RABIES VACC 2.5IU/ML 1ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"90675","type":"CPT"},{"code":"0636","type":"RC"},{"code":"50632-0010-01","type":"NDC"}],"standard_charges":[{"minimum":266.3,"maximum":3159.34,"gross_charge":3867,"discounted_cash":885.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1367.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":851.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":851.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2049.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3159.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.3,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":332.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":342.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":339.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":332.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":332.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":332.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":332.57,"methodology":"fee schedule"}]}]},{"description":"FLU VACC QV SPLIT PF 0.5ML IM","drug_information": {"unit": 0.5,"type": "UN"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0909-52","type":"NDC"}],"standard_charges":[{"minimum":58.58,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":59.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":60.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":59.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"}]}]},{"description":"FLU VACC QV SPLIT PF 0.5ML IM","drug_information": {"unit": 0.5,"type": "UN"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0909-52","type":"NDC"}],"standard_charges":[{"minimum":20.22,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":59.17,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":60.34,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":59.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITH MCC","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"minimum":32079.33,"maximum":82305.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74944,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74944,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43231.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32424.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32424.14,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":72510.98,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":59796.12,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82305.44,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":32079.33,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32400.13,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":33041.71,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32720.92,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":32079.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":32079.33,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":32079.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32881.32,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":32079.33,"methodology":"case rate"}]}]},{"description":"DIP-TET-ACEL PERT 0.5ML <7Y IM","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90700","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0810-52","type":"NDC"}],"standard_charges":[{"minimum":144.16,"maximum":222.23,"gross_charge":272,"discounted_cash":62.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"}]}]},{"description":"DIP-TET-ACEL PERT 0.5ML <7Y IM","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90700","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0810-52","type":"NDC"}],"standard_charges":[{"minimum":29.52,"maximum":222.23,"gross_charge":272,"discounted_cash":62.29,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":93.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":93.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"}]}]},{"description":"TET/DIP VACC PF 0.5ML>=7YRS IM","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90714","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0215-10","type":"NDC"}],"standard_charges":[{"minimum":204.05,"maximum":314.55,"gross_charge":385,"discounted_cash":88.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":204.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":314.55,"methodology":"fee schedule"}]}]},{"description":"TET/DIP VACC PF 0.5ML>=7YRS IM","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90714","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0215-10","type":"NDC"}],"standard_charges":[{"minimum":34.32,"maximum":314.55,"gross_charge":385,"discounted_cash":88.17,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":109.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":109.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":82.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":204.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":314.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"}]}]},{"description":"TDAP VACC 0.5ML >=7YR BOOSTER","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90715","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0842-11","type":"NDC"}],"standard_charges":[{"minimum":240.62,"maximum":370.92,"gross_charge":454,"discounted_cash":103.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":240.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":370.92,"methodology":"fee schedule"}]}]},{"description":"TDAP VACC 0.5ML >=7YR BOOSTER","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90715","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0842-11","type":"NDC"}],"standard_charges":[{"minimum":39.6,"maximum":370.92,"gross_charge":454,"discounted_cash":103.97,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":165.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":165.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":95.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":240.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":370.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL VACC 23 VAL 0.5ML","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90732","type":"CPT"},{"code":"0636","type":"RC"},{"code":"00006-4837-03","type":"NDC"}],"standard_charges":[{"minimum":346.55,"maximum":976.32,"gross_charge":1195,"discounted_cash":273.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":633.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":976.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":350.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":356.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":353.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":355.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL VACC 23 VAL 0.5ML","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"90732","type":"CPT"},{"code":"0636","type":"RC"},{"code":"00006-4837-03","type":"NDC"}],"standard_charges":[{"minimum":136.81,"maximum":976.32,"gross_charge":1195,"discounted_cash":273.66,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":431.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":431.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":229.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":633.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":976.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":350.02,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":356.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":353.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":355.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":346.55,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITH CC","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"minimum":16871.57,"maximum":42561.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38755,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38755,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27902.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20927.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20927.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":37496.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":30921.74,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42561.75,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16871.57,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17040.29,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17377.72,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17209.01,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16871.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16871.57,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16871.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":17293.36,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16871.57,"methodology":"case rate"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"minimum":11081.09,"maximum":27204.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24771,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24771,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22506.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16880.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16880.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23967.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19764.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27204.78,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11081.09,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11191.91,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11413.53,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11302.72,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11081.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11081.09,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11081.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11358.12,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11081.09,"methodology":"case rate"}]}]},{"description":"HEMODIALYSIS IP/NON ESRD OP","code_information":[{"code":"90935","type":"CPT"},{"code":"0829","type":"RC"}],"standard_charges":[{"minimum":1429.94,"maximum":2204.27,"gross_charge":2698,"discounted_cash":617.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1429.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2204.27,"methodology":"fee schedule"}]}]},{"description":"HEMODIALYSIS IP/NON ESRD OP","code_information":[{"code":"90935","type":"CPT"},{"code":"0829","type":"RC"}],"standard_charges":[{"minimum":74.03,"maximum":2204.27,"gross_charge":2698,"discounted_cash":617.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":990.17,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":990.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":593.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":593.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1429.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2204.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":753.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":768.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":760.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":764.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"}]}]},{"description":"HEMODIALYSIS REQ REPEAT EVAL","code_information":[{"code":"90937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DIALY CONT CYL PERIT CCPD","code_information":[{"code":"90945","type":"CPT"},{"code":"0831","type":"RC"}],"standard_charges":[{"minimum":782.81,"maximum":1206.71,"gross_charge":1477,"discounted_cash":338.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":782.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1206.71,"methodology":"fee schedule"}]}]},{"description":"DIALY CONT CYL PERIT CCPD","code_information":[{"code":"90945","type":"CPT"},{"code":"0831","type":"RC"}],"standard_charges":[{"minimum":89.4,"maximum":1206.71,"gross_charge":1477,"discounted_cash":338.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":542.06,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":542.06,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":348.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":261.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":261.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":782.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1206.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":458.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":467.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":462.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":465.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"}]}]},{"description":"DIALYSIS REPEATED EVAL","code_information":[{"code":"90947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DIALYSIS TRAINING/INCOMPLETE","code_information":[{"code":"90993","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DIALYSIS PROCEDURE","code_information":[{"code":"90999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9101","type":"APR-DRG"}],"standard_charges":[{"minimum":21655,"maximum":21655,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"}]}]},{"description":"STUDY ESOPHAGEAL MOTILITY","code_information":[{"code":"91010","type":"CPT"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1263.52,"maximum":1947.73,"gross_charge":2384,"discounted_cash":545.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1263.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1947.73,"methodology":"fee schedule"}]}]},{"description":"STUDY ESOPHAGEAL MOTILITY","code_information":[{"code":"91010","type":"CPT"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":232.09,"maximum":1947.73,"gross_charge":2384,"discounted_cash":545.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":436.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":436.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1263.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1947.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":565.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":571.18,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":582.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":576.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":565.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":565.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":565.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":579.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":565.52,"methodology":"fee schedule"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9102","type":"APR-DRG"}],"standard_charges":[{"minimum":21655,"maximum":21655,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9103","type":"APR-DRG"}],"standard_charges":[{"minimum":27433,"maximum":27433,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27433,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27433,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27433,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9104","type":"APR-DRG"}],"standard_charges":[{"minimum":47641,"maximum":47641,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47641,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47641,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47641,"methodology":"case rate"}]}]},{"description":"EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9111","type":"APR-DRG"}],"standard_charges":[{"minimum":12451,"maximum":12451,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12451,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12451,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12451,"methodology":"case rate"}]}]},{"description":"EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9112","type":"APR-DRG"}],"standard_charges":[{"minimum":13906,"maximum":13906,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13906,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13906,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13906,"methodology":"case rate"}]}]},{"description":"EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9113","type":"APR-DRG"}],"standard_charges":[{"minimum":19775,"maximum":19775,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19775,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19775,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19775,"methodology":"case rate"}]}]},{"description":"EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9114","type":"APR-DRG"}],"standard_charges":[{"minimum":46768,"maximum":46768,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":46768,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":46768,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":46768,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL HLTH TRXMNT/SERVICES - PARTIAL HOSPITALIZATION-LESS INTENSIVE","code_information":[{"code":"912","type":"RC"}],"standard_charges":[{"minimum":919.46,"maximum":1225.74,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1225.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9121","type":"APR-DRG"}],"standard_charges":[{"minimum":12988,"maximum":12988,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12988,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12988,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12988,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9122","type":"APR-DRG"}],"standard_charges":[{"minimum":14087,"maximum":14087,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14087,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14087,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14087,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9123","type":"APR-DRG"}],"standard_charges":[{"minimum":22825,"maximum":22825,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22825,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22825,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22825,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9124","type":"APR-DRG"}],"standard_charges":[{"minimum":43863,"maximum":43863,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43863,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43863,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43863,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL HLTH TRXMNT/SERVICES - PARTIAL HOSPITALIZATION-INTENSIVE","code_information":[{"code":"913","type":"RC"}],"standard_charges":[{"minimum":919.46,"maximum":1225.74,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1225.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRAUMATIC INJURY WITH MCC","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"minimum":10941.3,"maximum":30456.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27732,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27732,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14588.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10941.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10941.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26831.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22126.78,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30456.06,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13787.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13925.52,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14201.27,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14063.4,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13787.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13787.64,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13787.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14132.34,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13787.64,"methodology":"case rate"}]}]},{"description":"TRAUMATIC INJURY WITHOUT MCC","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"minimum":8359.84,"maximum":17776.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16187,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16187,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16609.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12457.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12457.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15661.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12915.15,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17776.87,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8359.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8443.44,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8610.64,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8527.04,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8359.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8359.84,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8359.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8568.84,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8359.84,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS WITH MCC","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"minimum":7174.79,"maximum":35052.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31917,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31917,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9566.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7174.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7174.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":30881.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25466.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35052.43,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14712.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14859.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15153.89,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15006.77,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14712.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14712.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14712.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15080.33,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14712.51,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS WITHOUT MCC","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"minimum":6408.8,"maximum":20392.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11894,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11894,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20392.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15294.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15294.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":11508.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":9490.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13062.91,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6472.89,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6601.07,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6536.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6569.02,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6408.8,"methodology":"case rate"}]}]},{"description":"POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"minimum":8986.66,"maximum":30185.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27486,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27486,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11981.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8986.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8986.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26593.66,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21930.44,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30185.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13953.13,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14092.67,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14371.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14232.2,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13953.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13953.13,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13953.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14301.96,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13953.13,"methodology":"case rate"}]}]},{"description":"POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"minimum":8113.93,"maximum":28297.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14727,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14727,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28297.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21223.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21223.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14249.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11750.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16173.92,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8113.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8195.07,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8357.35,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8276.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8113.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8113.93,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8113.93,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8316.78,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8113.93,"methodology":"case rate"}]}]},{"description":"COMPLICATIONS OF TREATMENT WITH MCC","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":15375.23,"maximum":37655.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34288,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34288,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21607.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16205.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16205.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":33174.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27357.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37655.93,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":15375.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":15528.99,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":15836.49,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":15682.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":15375.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":15375.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":15375.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":15759.62,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":15375.23,"methodology":"case rate"}]}]},{"description":"COMPLICATIONS OF TREATMENT WITH CC","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"minimum":9129.27,"maximum":20784.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18925,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18925,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15661.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11746,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11746,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":18311.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":15100.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20784.72,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9129.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9220.57,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9403.15,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9311.86,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9129.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9129.27,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9129.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9357.51,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9129.27,"methodology":"case rate"}]}]},{"description":"OTHER DIAGNOSTIC SERVICES","code_information":[{"code":"920","type":"RC"}],"standard_charges":[{"minimum":211,"maximum":258,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":254,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":211,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":258,"methodology":"case rate"}]}]},{"description":"SLEEP STUDIES","code_information":[{"code":"920","type":"RC"}],"standard_charges":[{"minimum":2010,"maximum":2434,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2405,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2434,"methodology":"case rate"}]}]},{"description":"COMPLICATIONS OF TREATMENT WITHOUT CC/MCC","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"minimum":6591.3,"maximum":20807.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12972,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12972,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20807.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15605.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15605.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":12551.65,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":10350.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14247.07,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6591.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6657.22,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6789.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6723.13,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6591.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6591.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6591.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6756.09,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6591.3,"methodology":"case rate"}]}]},{"description":"PERIPHERAL VASCULAR LAB","code_information":[{"code":"921","type":"RC"}],"standard_charges":[{"minimum":710,"maximum":859,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":710,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":859,"methodology":"case rate"}]}]},{"description":"EMG","code_information":[{"code":"922","type":"RC"}],"standard_charges":[{"minimum":958,"maximum":1156,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":1141,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":958,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1156,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"minimum":9731.65,"maximum":33082.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30123,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30123,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12975.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9731.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9731.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29145.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24034.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33082.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14337.46,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14480.84,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14767.59,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14624.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14337.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14337.46,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14337.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14695.9,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14337.46,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"minimum":9160.21,"maximum":390307.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16258,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16258,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390307.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":292736.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":292736.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":15730.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":12972.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17855.26,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9251.82,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9435.02,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9343.42,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9389.22,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9160.21,"methodology":"case rate"}]}]},{"description":"ALLERGY TESTING","code_information":[{"code":"924","type":"RC"}],"standard_charges":[{"minimum":212,"maximum":258,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":254,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":212,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":258,"methodology":"case rate"}]}]},{"description":"ST TREATMENT SPEECH","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":214.12,"maximum":330.07,"gross_charge":404,"discounted_cash":92.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":214.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.07,"methodology":"fee schedule"}]}]},{"description":"ST TREATMENT SPEECH","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":40.69,"maximum":330.07,"gross_charge":404,"discounted_cash":92.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":98.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":98.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":214.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.69,"methodology":"fee schedule"}]}]},{"description":"NASOPHARYNGOSCOPY W ENDO","code_information":[{"code":"92511","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":416.05,"maximum":641.35,"gross_charge":785,"discounted_cash":179.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":416.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":641.35,"methodology":"fee schedule"}]}]},{"description":"NASOPHARYNGOSCOPY W ENDO","code_information":[{"code":"92511","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":39.7,"maximum":641.35,"gross_charge":785,"discounted_cash":179.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":213.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":213.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":416.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":641.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":208.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":213.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":212.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":206.92,"methodology":"fee schedule"}]}]},{"description":"ST EVAL FLUENCY SPEECH","code_information":[{"code":"92521","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":354.04,"maximum":545.76,"gross_charge":668,"discounted_cash":152.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":354.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":545.76,"methodology":"fee schedule"}]}]},{"description":"ST EVAL FLUENCY SPEECH","code_information":[{"code":"92521","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":140.9,"maximum":545.76,"gross_charge":668,"discounted_cash":152.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":520.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":390.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":390.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":354.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":545.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"}]}]},{"description":"ST EVAL PRODUCTION SPEECH","code_information":[{"code":"92522","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":296.8,"maximum":457.52,"gross_charge":560,"discounted_cash":128.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":296.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":457.52,"methodology":"fee schedule"}]}]},{"description":"ST EVAL PRODUCTION SPEECH","code_information":[{"code":"92522","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":118.01,"maximum":457.52,"gross_charge":560,"discounted_cash":128.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":378.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":378.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":316.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":316.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":296.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":457.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.01,"methodology":"fee schedule"}]}]},{"description":"ST EVL PROD/COMPREHENSN SP","code_information":[{"code":"92523","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":635.47,"maximum":979.59,"gross_charge":1199,"discounted_cash":274.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":635.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":979.59,"methodology":"fee schedule"}]}]},{"description":"ST EVL PROD/COMPREHENSN SP","code_information":[{"code":"92523","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":241.39,"maximum":979.59,"gross_charge":1199,"discounted_cash":274.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":770.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":770.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":877.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":658.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":658.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":635.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":979.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.39,"methodology":"fee schedule"}]}]},{"description":"ST ANALY BEHAV QUAL VOICE","code_information":[{"code":"92524","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":291.5,"maximum":449.35,"gross_charge":550,"discounted_cash":125.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":291.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":449.35,"methodology":"fee schedule"}]}]},{"description":"ST ANALY BEHAV QUAL VOICE","code_information":[{"code":"92524","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":116.23,"maximum":449.35,"gross_charge":550,"discounted_cash":125.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":330.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":330.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":291.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":449.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.23,"methodology":"fee schedule"}]}]},{"description":"ST TREATMENT SWALLOW","code_information":[{"code":"92526","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":227.37,"maximum":350.5,"gross_charge":429,"discounted_cash":98.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.5,"methodology":"fee schedule"}]}]},{"description":"ST TREATMENT SWALLOW","code_information":[{"code":"92526","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":89.76,"maximum":350.5,"gross_charge":429,"discounted_cash":98.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":102.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":102.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":227.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.76,"methodology":"fee schedule"}]}]},{"description":"ST EVAL DVC COMMUNICATN ADD 30","code_information":[{"code":"92608","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"}]}]},{"description":"ST EVAL DVC COMMUNICATN ADD 30","code_information":[{"code":"92608","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":129.59,"maximum":370.13,"gross_charge":300,"discounted_cash":68.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":277.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":277.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.59,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.59,"methodology":"fee schedule"}]}]},{"description":"ST EVAL SWALLOWING","code_information":[{"code":"92610","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":238.5,"maximum":367.65,"gross_charge":450,"discounted_cash":103.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":238.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":367.65,"methodology":"fee schedule"}]}]},{"description":"ST EVAL SWALLOWING","code_information":[{"code":"92610","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":74.38,"maximum":382.07,"gross_charge":450,"discounted_cash":103.05,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":286.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":286.6,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":238.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":367.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.38,"methodology":"fee schedule"}]}]},{"description":"ST EVAL FLUORO SWALLOW VID","code_information":[{"code":"92611","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":257.05,"maximum":396.25,"gross_charge":485,"discounted_cash":111.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":257.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":396.25,"methodology":"fee schedule"}]}]},{"description":"ST EVAL FLUORO SWALLOW VID","code_information":[{"code":"92611","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":97.27,"maximum":415.84,"gross_charge":485,"discounted_cash":111.07,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":415.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":311.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":311.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":257.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":396.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.27,"methodology":"fee schedule"}]}]},{"description":"ST EVAL ENDO SWALLOW VID","code_information":[{"code":"92612","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":446.26,"maximum":687.92,"gross_charge":842,"discounted_cash":192.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":446.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":687.92,"methodology":"fee schedule"}]}]},{"description":"ST EVAL ENDO SWALLOW VID","code_information":[{"code":"92612","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":69.74,"maximum":687.92,"gross_charge":842,"discounted_cash":192.82,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":248.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":248.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":446.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":687.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"minimum":93770.68,"maximum":411434.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374638,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374638,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125025.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":93770.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":93770.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":362473.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":298913.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":411434.4,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":184722.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":186569.4,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":190263.84,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":188416.62,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":184722.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":184722.17,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":184722.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":189340.23,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":184722.17,"methodology":"case rate"}]}]},{"description":"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"minimum":50202.77,"maximum":127800.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116371,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116371,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66935.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50202.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50202.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":112592.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":92849.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":127800.78,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":52921.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":53450.58,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":54509.01,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":53979.79,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":52921.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":52921.36,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":52921.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":54244.4,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":52921.36,"methodology":"case rate"}]}]},{"description":"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"minimum":25867.39,"maximum":69836.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55256,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55256,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69836.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52378.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52378.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":53461.76,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":44087.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":60683.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25867.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26126.07,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26643.42,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26384.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25867.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25867.39,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25867.39,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26514.08,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25867.39,"methodology":"case rate"}]}]},{"description":"OTHER DIAGNOSTIC SERVICES","code_information":[{"code":"929","type":"RC"}],"standard_charges":[{"minimum":211,"maximum":258,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":254,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":211,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":258,"methodology":"case rate"}]}]},{"description":"SLEEP STUDIES","code_information":[{"code":"929","type":"RC"}],"standard_charges":[{"minimum":2010,"maximum":2434,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":2405,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":2010,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2434,"methodology":"case rate"}]}]},{"description":"PTCA WITHOUT STENT","code_information":[{"code":"92920","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"PTCA WITHOUT STENT","code_information":[{"code":"92921","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"PTCA WITHOUT STENT","code_information":[{"code":"92924","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"PTCA WITHOUT STENT","code_information":[{"code":"92925","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92928","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"standard_charge_algorithm": " ","count":"0","methodology":"case rate", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92929","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"methodology":"case rate"}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92933","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"methodology":"case rate"}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92934","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"methodology":"case rate"}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92937","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"methodology":"case rate"}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92938","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"methodology":"case rate"}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92941","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"methodology":"case rate"}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92943","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"methodology":"case rate"}]}]},{"description":"PTCA WITH NON-DRUG ELUTING STENT","code_information":[{"code":"92944","type":"CPT"}],"standard_charges":[{"minimum":63926,"maximum":82255,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":80947,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":63926,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":82255,"methodology":"case rate"}]}]},{"description":"CPR","code_information":[{"code":"92950","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":758.43,"maximum":1169.13,"gross_charge":1431,"discounted_cash":327.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":758.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1169.13,"methodology":"fee schedule"}]}]},{"description":"CPR","code_information":[{"code":"92950","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":190.61,"maximum":1169.13,"gross_charge":1431,"discounted_cash":327.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":587.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":587.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":758.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1169.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":341.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":338.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"}]}]},{"description":"EMERG ROOM CPR","code_information":[{"code":"92950","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":758.43,"maximum":1169.13,"gross_charge":1431,"discounted_cash":327.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":758.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1169.13,"methodology":"fee schedule"}]}]},{"description":"EMERG ROOM CPR","code_information":[{"code":"92950","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":190.61,"maximum":1169.13,"gross_charge":1431,"discounted_cash":327.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":587.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":587.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":758.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1169.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":341.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":338.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"}]}]},{"description":"PACING TRANSCUTANEOUS","code_information":[{"code":"92953","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":802.95,"maximum":1237.76,"gross_charge":1515,"discounted_cash":346.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":802.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1237.76,"methodology":"fee schedule"}]}]},{"description":"PACING TRANSCUTANEOUS","code_information":[{"code":"92953","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":1237.76,"gross_charge":1515,"discounted_cash":346.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":783.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":587.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":587.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":802.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1237.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":704.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":718.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":714.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"}]}]},{"description":"CARDIOVERSION ELECTIVE EXTRNAL","code_information":[{"code":"92960","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1367.4,"maximum":2107.86,"gross_charge":2580,"discounted_cash":590.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1367.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2107.86,"methodology":"fee schedule"}]}]},{"description":"CARDIOVERSION ELECTIVE EXTRNAL","code_information":[{"code":"92960","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":111.93,"maximum":2107.86,"gross_charge":2580,"discounted_cash":590.82,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1736.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1302.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1302.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1367.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2107.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":704.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":718.38,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":711.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":714.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"}]}]},{"description":"THROMBOLYSIS CORONARY IV","code_information":[{"code":"92977","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":821.5,"maximum":1266.35,"gross_charge":1550,"discounted_cash":354.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":821.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1266.35,"methodology":"fee schedule"}]}]},{"description":"THROMBOLYSIS CORONARY IV","code_information":[{"code":"92977","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":57.22,"maximum":1266.35,"gross_charge":1550,"discounted_cash":354.95,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":593.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":593.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":821.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1266.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":364.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":360.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":362.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":353.52,"methodology":"fee schedule"}]}]},{"description":"ELECTROCARDIOGRAM COMPLETE","code_information":[{"code":"93000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG 12 LEAD TRACING ONLY","code_information":[{"code":"93005","type":"CPT"},{"code":"0730","type":"RC"}],"standard_charges":[{"minimum":438.31,"maximum":675.66,"gross_charge":827,"discounted_cash":189.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":438.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":675.66,"methodology":"fee schedule"}]}]},{"description":"ECG 12 LEAD TRACING ONLY","code_information":[{"code":"93005","type":"CPT"},{"code":"0730","type":"RC"}],"standard_charges":[{"minimum":6.44,"maximum":675.66,"gross_charge":827,"discounted_cash":189.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":303.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":303.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":438.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":675.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE","code_information":[{"code":"9301","type":"APR-DRG"}],"standard_charges":[{"minimum":4850,"maximum":4850,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4850,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4850,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4850,"methodology":"case rate"}]}]},{"description":"ELECTROCARDIOGRAM REPORT","code_information":[{"code":"93010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIOVASCULAR STRESS TEST","code_information":[{"code":"93015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIOVASCULAR STRESS TEST","code_information":[{"code":"93016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIOVAS STR TEST WO RX","code_information":[{"code":"93017","type":"CPT"},{"code":"0482","type":"RC"}],"standard_charges":[{"minimum":561.27,"maximum":865.21,"gross_charge":1059,"discounted_cash":242.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":561.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":865.21,"methodology":"fee schedule"}]}]},{"description":"CARDIOVAS STR TEST WO RX","code_information":[{"code":"93017","type":"CPT"},{"code":"0482","type":"RC"}],"standard_charges":[{"minimum":39.34,"maximum":865.21,"gross_charge":1059,"discounted_cash":242.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":388.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":388.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":238.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":238.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":561.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":865.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":341.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":338.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"}]}]},{"description":"CARDIO TESTINTERPRET/REPORT","code_information":[{"code":"93018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93019","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE","code_information":[{"code":"9302","type":"APR-DRG"}],"standard_charges":[{"minimum":6276,"maximum":6276,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6276,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6276,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93023","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIAC DRUG STRESS TEST","code_information":[{"code":"93024","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MICROVOLT T-WAVE ASSESS","code_information":[{"code":"93025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93026","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93027","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93028","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93029","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE","code_information":[{"code":"9303","type":"APR-DRG"}],"standard_charges":[{"minimum":9960,"maximum":9960,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9960,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9960,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9960,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93033","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93037","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93039","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE","code_information":[{"code":"9304","type":"APR-DRG"}],"standard_charges":[{"minimum":20641,"maximum":20641,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20641,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20641,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20641,"methodology":"case rate"}]}]},{"description":"RHYTHM ECG WITH REPORT","code_information":[{"code":"93040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG 1-3 LEAD TRACING ONLY","code_information":[{"code":"93041","type":"CPT"},{"code":"0730","type":"RC"}],"standard_charges":[{"minimum":314.29,"maximum":484.49,"gross_charge":593,"discounted_cash":135.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":314.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":484.49,"methodology":"fee schedule"}]}]},{"description":"ECG 1-3 LEAD TRACING ONLY","code_information":[{"code":"93041","type":"CPT"},{"code":"0730","type":"RC"}],"standard_charges":[{"minimum":6.44,"maximum":484.49,"gross_charge":593,"discounted_cash":135.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":314.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":484.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":64.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"}]}]},{"description":"RHYTHM ECG REPORT","code_information":[{"code":"93042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART PRESSURE WAVEFORM ANALYS","code_information":[{"code":"93050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93054","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93058","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93059","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93063","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93064","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93067","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93068","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93069","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93072","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93078","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93079","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93084","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93087","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93089","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93091","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93092","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93093","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93094","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93095","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93096","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93097","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93098","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93099","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93127","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93136","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93137","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93138","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93144","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93148","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93149","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THERAPY ACTIVATION IPNSS","code_information":[{"code":"93150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERROG&PRGRMG IPNSS","code_information":[{"code":"93151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERROG&PRGRMG IPNSS POLYSM","code_information":[{"code":"93152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERROG W/O PRGRMG IPNSS","code_information":[{"code":"93153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93159","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93167","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93168","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93169","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93174","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93176","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93179","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93183","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93187","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93188","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93189","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93194","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93196","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93199","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93209","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93217","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93218","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93219","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93223","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG MONIT/REPRT UP TO 48 HRS","code_information":[{"code":"93224","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG MONIT/REPRT UP TO 48 HRS","code_information":[{"code":"93225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG MONIT/REPRT UP TO 48 HRS","code_information":[{"code":"93226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG MONIT/REPRT UP TO 48 HRS","code_information":[{"code":"93227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOTE 30 DAY ECG REV/REPORT","code_information":[{"code":"93228","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOTE 30 DAY ECG TECH SUPP","code_information":[{"code":"93229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93234","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93237","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT ECG>48HR<7D REC SCAN A/R","code_information":[{"code":"93241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT ECG>48HR<7D RECORDING","code_information":[{"code":"93242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT ECG>48HR<7D SCAN A/R","code_information":[{"code":"93243","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT ECG>48HR<7D REV&INTERPJ","code_information":[{"code":"93244","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT ECG>7D<15D REC SCAN A/R","code_information":[{"code":"93245","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT ECG>7D<15D RECORDING","code_information":[{"code":"93246","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT ECG>7D<15D SCAN A/R","code_information":[{"code":"93247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT ECG>7D<15D REV&INTERPJ","code_information":[{"code":"93248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93249","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93253","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93254","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93257","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93258","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93259","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRGRMG DEV EVAL IMPLTBL SYS","code_information":[{"code":"93260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERROGATE SUBQ DEFIB","code_information":[{"code":"93261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REM MNTR WRLS P-ART PRS SNR","code_information":[{"code":"93264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93266","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG RECORD/REVIEW","code_information":[{"code":"93268","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93269","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOTE 30 DAY ECG REV/REPORT","code_information":[{"code":"93270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG/MONITORING AND ANALYSIS","code_information":[{"code":"93271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECG/REVIEW INTERPRET ONLY","code_information":[{"code":"93272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SIGNAL-AVERAGED ECG","code_information":[{"code":"93278","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRGRMG DEV EVAL PM/LDLS PM","code_information":[{"code":"93279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PM DEVICE PROGR EVAL DUAL","code_information":[{"code":"93280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PM DEVICE PROGR EVAL MULTI","code_information":[{"code":"93281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRGRMG EVAL IMPLANTABLE DFB","code_information":[{"code":"93282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRGRMG EVAL IMPLANTABLE DFB","code_information":[{"code":"93283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRGRMG EVAL IMPLANTABLE DFB","code_information":[{"code":"93284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRGRMG DEV EVAL SCRMS IP","code_information":[{"code":"93285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERI-PX EVAL PM/LDLS PM IP","code_information":[{"code":"93286","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERI-PX DEVICE EVAL & PRGR","code_information":[{"code":"93287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERROG EVL PM/LDLS PM IP","code_information":[{"code":"93288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERROG DEVICE EVAL HEART","code_information":[{"code":"93289","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERROG DEV EVAL ICPMS IP","code_information":[{"code":"93290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERROG DEV EVAL SCRMS IP","code_information":[{"code":"93291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"WCD DEVICE INTERROGATE","code_information":[{"code":"93292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PM PHONE R-STRIP DEVICE EVAL","code_information":[{"code":"93293","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REM INTERROG EVL PM/LDLS PM","code_information":[{"code":"93294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DEV INTERROG REMOTE 1/2/MLT","code_information":[{"code":"93295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REM INTERROG EVL PM/IDS","code_information":[{"code":"93296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REM INTERROG DEV EVAL ICPMS","code_information":[{"code":"93297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REM INTERROG DEV EVAL SCRMS","code_information":[{"code":"93298","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"minimum":24190.26,"maximum":64782.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58988,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58988,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32253.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24190.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24190.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":57073.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":47065.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64782.32,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":34733.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":35080.64,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":35775.3,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":35427.97,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":34733.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":34733.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":34733.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":35601.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":34733.3,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO TRANSTHOACIC","code_information":[{"code":"93303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO TRANSTHORACIC","code_information":[{"code":"93304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TTE W DOPPLER COMPLETE","code_information":[{"code":"93306","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2180.42,"maximum":3361.14,"gross_charge":4114,"discounted_cash":942.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2180.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3361.14,"methodology":"fee schedule"}]}]},{"description":"TTE W DOPPLER COMPLETE","code_information":[{"code":"93306","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":206.35,"maximum":3361.14,"gross_charge":4114,"discounted_cash":942.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1509.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1509.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1255.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":941.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":941.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2180.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3361.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":601.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"}]}]},{"description":"TTE W/O DOPPLER COMPLETE","code_information":[{"code":"93307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO 2D LTD WO CON","code_information":[{"code":"93308","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":912.13,"maximum":1406.06,"gross_charge":1721,"discounted_cash":394.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":912.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1406.06,"methodology":"fee schedule"}]}]},{"description":"ECHO 2D LTD WO CON","code_information":[{"code":"93308","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":103.35,"maximum":1406.06,"gross_charge":1721,"discounted_cash":394.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":631.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":332.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":332.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":912.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1406.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO TEE WO CON","code_information":[{"code":"93312","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1973.72,"maximum":3042.51,"gross_charge":3724,"discounted_cash":852.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1973.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3042.51,"methodology":"fee schedule"}]}]},{"description":"ECHO TEE WO CON","code_information":[{"code":"93312","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":247.83,"maximum":3042.51,"gross_charge":3724,"discounted_cash":852.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1366.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1366.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1124.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":843.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":843.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1973.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3042.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":601.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"}]}]},{"description":"ECHO TRANSESOPHAGEAL2","code_information":[{"code":"93313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO TRANSESOPHAGEAL4","code_information":[{"code":"93314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO TRANSESOPHAGEAL8","code_information":[{"code":"93315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO TRANSESOPHAGEAL3","code_information":[{"code":"93316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO TRANSESOPHAGEAL5","code_information":[{"code":"93317","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANESTH ECG TRANSESOPH6","code_information":[{"code":"93318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"3D ECHO IMG CGEN CAR ANOMAL","code_information":[{"code":"93319","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DOP ECHO COMP STUDY ADDON","code_information":[{"code":"93320","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":505.62,"maximum":779.42,"gross_charge":954,"discounted_cash":218.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":505.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":779.42,"methodology":"fee schedule"}]}]},{"description":"DOP ECHO COMP STUDY ADDON","code_information":[{"code":"93320","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":53.28,"maximum":779.42,"gross_charge":954,"discounted_cash":218.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":350.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":231.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":231.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":505.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":779.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"}]}]},{"description":"DOP ECHO LMTD STUDY ADDON","code_information":[{"code":"93321","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":401.21,"maximum":618.47,"gross_charge":757,"discounted_cash":173.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":401.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":618.47,"methodology":"fee schedule"}]}]},{"description":"DOP ECHO LMTD STUDY ADDON","code_information":[{"code":"93321","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":26.11,"maximum":618.47,"gross_charge":757,"discounted_cash":173.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":277.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":277.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":401.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":618.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DOP ECHO COLOR FLOW ADDON","code_information":[{"code":"93325","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":477.53,"maximum":736.12,"gross_charge":901,"discounted_cash":206.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":477.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":736.12,"methodology":"fee schedule"}]}]},{"description":"DOP ECHO COLOR FLOW ADDON","code_information":[{"code":"93325","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":24.32,"maximum":736.12,"gross_charge":901,"discounted_cash":206.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":265.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":198.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":198.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":477.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":736.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93329","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93338","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93339","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93346","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93349","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECHO STR TEST COMP WO CON","code_information":[{"code":"93350","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1092.33,"maximum":1683.84,"gross_charge":2061,"discounted_cash":471.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1092.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1683.84,"methodology":"fee schedule"}]}]},{"description":"ECHO STR TEST COMP WO CON","code_information":[{"code":"93350","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":194.9,"maximum":1683.84,"gross_charge":2061,"discounted_cash":471.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":756.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":756.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":705.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":529.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":529.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1092.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1683.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":601.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"}]}]},{"description":"ECHO STR TEST COMP W ECG","code_information":[{"code":"93351","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1107.7,"maximum":1707.53,"gross_charge":2090,"discounted_cash":478.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1107.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1707.53,"methodology":"fee schedule"}]}]},{"description":"ECHO STR TEST COMP W ECG","code_information":[{"code":"93351","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":243.89,"maximum":1707.53,"gross_charge":2090,"discounted_cash":478.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":767.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":767.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":921.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":691.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":691.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1107.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1707.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":590.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":601.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":596.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":599,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":584.39,"methodology":"fee schedule"}]}]},{"description":"ADMIN ECG CONTRAST AGENT","code_information":[{"code":"93352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"minimum":17866.81,"maximum":37336.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33997,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33997,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24742.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18557.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18557.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":32893.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":27125.28,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37336.17,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17866.81,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18045.48,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18402.82,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18224.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17866.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17866.81,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17866.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18313.49,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17866.81,"methodology":"case rate"}]}]},{"description":"RIGHT HEART CATH","code_information":[{"code":"93451","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEFT HRT CATH W/VENTRCLGRPHY","code_information":[{"code":"93452","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"R&L HRT CATH W/VENTRICLGRPHY","code_information":[{"code":"93453","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORONARY ARTERY ANGIO S&I","code_information":[{"code":"93454","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORONARY ART/GRFT ANGIO S&I","code_information":[{"code":"93455","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"R HRT CORONARY ARTERY ANGIO","code_information":[{"code":"93456","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"R HRT ART/GRFT ANGIO","code_information":[{"code":"93457","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"L HRT ARTERY/VENTRICLE ANGIO","code_information":[{"code":"93458","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"L HRT ART/GRFT ANGIO","code_information":[{"code":"93459","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"R&L HRT ART/VENTRICLE ANGIO","code_information":[{"code":"93460","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"R&L HRT ART/VENTRICLE ANGIO","code_information":[{"code":"93461","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"L HRT CATH TRNSPTL PUNCTURE","code_information":[{"code":"93462","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NON-EXTENSIVE BURNS","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"minimum":18258.1,"maximum":50073.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36298,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36298,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50073.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":37556.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":37556.03,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35119.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28961.31,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39863.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":18258.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":18440.69,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18805.85,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":18623.27,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":18258.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":18258.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":18258.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18714.56,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":18258.1,"methodology":"case rate"}]}]},{"description":"INSER. OF FLOW DIR. CATH 10","code_information":[{"code":"93503","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93504","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BIOPSY OF HEART LINING","code_information":[{"code":"93505","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RT HEART CATH CONGENITAL","code_information":[{"code":"93530","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"R  L HEART CATH CONGENITAL","code_information":[{"code":"93531","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"R  L HEART CATH CONGENITAL","code_information":[{"code":"93532","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"R  L HEART CATH CONGENITAL","code_information":[{"code":"93533","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERQ TRANSCATH CLS MITRAL","code_information":[{"code":"93590","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERQ TRANSCATH CLS AORTIC","code_information":[{"code":"93591","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERQ TRANSCATH CLOSURE EACH","code_information":[{"code":"93592","type":"CPT"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93600","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93602","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93603","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93609","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93610","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93612","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93613","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93615","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93616","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93618","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"COMPREHENSIVE ELECTROPHYSIOLOGIC EVAL","code_information":[{"code":"93619","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY EVALUATION","code_information":[{"code":"93619","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COMPREHENSIVE ELECTROPHYSIOLOGIC EVAL","code_information":[{"code":"93620","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY EVALUATION","code_information":[{"code":"93620","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGY EVALUATION","code_information":[{"code":"93621","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93621","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY EVALUATION","code_information":[{"code":"93622","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93622","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93623","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"STIMULATION PACING HEART","code_information":[{"code":"93623","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COMPREHENSIVE ELECTROPHYSIOLOGIC EVAL","code_information":[{"code":"93624","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYS. FOLLOW-UP","code_information":[{"code":"93624","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93631","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93640","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93641","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93642","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGY STUDIES","code_information":[{"code":"93644","type":"CPT"}],"standard_charges":[{"minimum":17048,"maximum":21938,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21938,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGIC ABLATION","code_information":[{"code":"93650","type":"CPT"}],"standard_charges":[{"minimum":8522,"maximum":10968,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8522,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10968,"methodology":"case rate"}]}]},{"description":"INTRACARDIAC CATHETER","code_information":[{"code":"93650","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COMPRE EP EVAL TX SVT","code_information":[{"code":"93653","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGIC ABLATION","code_information":[{"code":"93653","type":"CPT"}],"standard_charges":[{"minimum":8522,"maximum":10968,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8522,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10968,"methodology":"case rate"}]}]},{"description":"COMPRE EP EVAL TX VT","code_information":[{"code":"93654","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGIC ABLATION","code_information":[{"code":"93654","type":"CPT"}],"standard_charges":[{"minimum":8522,"maximum":10968,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8522,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10968,"methodology":"case rate"}]}]},{"description":"ABLATE ARRHYTHMIA ADD ON","code_information":[{"code":"93655","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGIC ABLATION","code_information":[{"code":"93655","type":"CPT"}],"standard_charges":[{"minimum":8522,"maximum":10968,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8522,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10968,"methodology":"case rate"}]}]},{"description":"COMPRE EP EVAL ABLTJ ATR FIB","code_information":[{"code":"93656","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ELECTROPHYSIOLOGIC ABLATION","code_information":[{"code":"93656","type":"CPT"}],"standard_charges":[{"minimum":8522,"maximum":10968,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8522,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10968,"methodology":"case rate"}]}]},{"description":"ELECTROPHYSIOLOGIC ABLATION","code_information":[{"code":"93657","type":"CPT"}],"standard_charges":[{"minimum":8522,"maximum":10968,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10794,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8522,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10968,"methodology":"case rate"}]}]},{"description":"TX L/R ATRIAL FIB ADDL","code_information":[{"code":"93657","type":"CPT"}],"standard_charges":[{"minimum":25168,"maximum":25168,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25168,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"US DUPLEX EXTRACRANIAL CMP BIL","code_information":[{"code":"93880","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1795.11,"maximum":2767.18,"gross_charge":3387,"discounted_cash":775.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1795.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2767.18,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX EXTRACRANIAL CMP BIL","code_information":[{"code":"93880","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":199.19,"maximum":2767.18,"gross_charge":3387,"discounted_cash":775.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1243.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1243.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":993.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":745.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":745.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1795.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2767.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NON-INVASIVE VASCULAR STUDY","code_information":[{"code":"93882","type":"CPT"}],"standard_charges":[{"minimum":383.01,"maximum":383.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93884","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSCRANIAL DOPPLER STUDY","code_information":[{"code":"93886","type":"CPT"}],"standard_charges":[{"minimum":836.78,"maximum":836.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93887","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSCRANIAL DOPPLER--F/U","code_information":[{"code":"93888","type":"CPT"}],"standard_charges":[{"minimum":383.01,"maximum":383.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93889","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TCD VASOREACTIVITY STUDY","code_information":[{"code":"93890","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSCRANIAL DOPPLER STUDY","code_information":[{"code":"93892","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TCD STD ICR ART VEN-ART SHNT","code_information":[{"code":"93893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93894","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CAROTID INTIMA ATHEROMA EVA","code_information":[{"code":"93895","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VSRCTV STD TCD ICR ART COMPL","code_information":[{"code":"93896","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EMBOLI DETCJ WO IV MBUBB NJX","code_information":[{"code":"93897","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VEN-ARTL SHUNT DET MBUBB NJX","code_information":[{"code":"93898","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"minimum":25817.9,"maximum":75390.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68647,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68647,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38870.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29153.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29153.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":66418.72,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":54772.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":75390.27,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":25817.9,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":26076.08,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":26592.44,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":26334.26,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":25817.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":25817.9,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":25817.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":26463.35,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":25817.9,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93907","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93909","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93910","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93914","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93915","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93916","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93917","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93919","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UPR/L XTREMITY ART 2 LEVELS","code_information":[{"code":"93922","type":"CPT"}],"standard_charges":[{"minimum":416.08,"maximum":416.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":416.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":416.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UPR/LXTR ART STDY 3+ LVLS","code_information":[{"code":"93923","type":"CPT"}],"standard_charges":[{"minimum":521.12,"maximum":521.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":521.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":521.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"US DOP ART LOW EXT W/S CMP BIL","code_information":[{"code":"93924","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":400.68,"maximum":617.66,"gross_charge":756,"discounted_cash":173.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":400.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":617.66,"methodology":"fee schedule"}]}]},{"description":"US DOP ART LOW EXT W/S CMP BIL","code_information":[{"code":"93924","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":166.76,"maximum":1088.25,"gross_charge":756,"discounted_cash":173.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":277.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":277.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1088.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":816.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":816.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1003.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1003.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":400.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":617.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX ART LOW EXT CMP BIL","code_information":[{"code":"93925","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1167.59,"maximum":1799.86,"gross_charge":2203,"discounted_cash":504.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1167.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1799.86,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX ART LOW EXT CMP BIL","code_information":[{"code":"93925","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":251.76,"maximum":1799.86,"gross_charge":2203,"discounted_cash":504.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":808.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":808.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1158.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":869.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":869.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1167.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1799.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"US DPLX ARTERIAL LOW EXTREM LT","code_information":[{"code":"93926","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":782.28,"maximum":1205.9,"gross_charge":1476,"discounted_cash":338.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":782.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1205.9,"methodology":"fee schedule"}]}]},{"description":"US DPLX ARTERIAL LOW EXTREM LT","code_information":[{"code":"93926","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1205.9,"gross_charge":1476,"discounted_cash":338.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":541.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":541.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":552.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":552.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":782.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1205.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93928","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"US DUPLEX ART UPPR EXT CMP BIL","code_information":[{"code":"93930","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":696.42,"maximum":1073.54,"gross_charge":1314,"discounted_cash":300.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":696.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1073.54,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX ART UPPR EXT CMP BIL","code_information":[{"code":"93930","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":207.42,"maximum":1073.54,"gross_charge":1314,"discounted_cash":300.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":482.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":482.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1000.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":750.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":750.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":696.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1073.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX ART UPPR EXTREM LT","code_information":[{"code":"93931","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":508.27,"maximum":783.51,"gross_charge":959,"discounted_cash":219.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":508.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":783.51,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX ART UPPR EXTREM LT","code_information":[{"code":"93931","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":783.51,"gross_charge":959,"discounted_cash":219.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":351.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":351.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":657.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":492.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":492.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":508.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":783.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93934","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93939","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93942","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93944","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93946","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93949","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93952","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93953","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93954","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93956","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93957","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93958","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93959","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93963","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93964","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93966","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93967","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93968","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93969","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"US DUPLEX VENOUS EXTREMITY BIL","code_information":[{"code":"93970","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1218.47,"maximum":1878.29,"gross_charge":2299,"discounted_cash":526.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1218.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1878.29,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX VENOUS EXTREMITY BIL","code_information":[{"code":"93970","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":195.97,"maximum":1878.29,"gross_charge":2299,"discounted_cash":526.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":843.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":843.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":996.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":747.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":747.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1218.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1878.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX VENOUS EXTREMITY LT","code_information":[{"code":"93971","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":909.48,"maximum":1401.98,"gross_charge":1716,"discounted_cash":392.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":909.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1401.98,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX VENOUS EXTREMITY LT","code_information":[{"code":"93971","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1401.98,"gross_charge":1716,"discounted_cash":392.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":629.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":629.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":649.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":487.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":487.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":909.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1401.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"US DUPLEX ABD/PELV/RETRO CMP","code_information":[{"code":"93975","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1016.54,"maximum":1567.01,"gross_charge":1918,"discounted_cash":439.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1016.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1567.01,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX ABD/PELV/RETRO CMP","code_information":[{"code":"93975","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":257.63,"maximum":1567.01,"gross_charge":1918,"discounted_cash":439.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":703.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":703.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1175.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":881.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":881.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1016.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1567.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX ABD/PELV/RETRO LTD","code_information":[{"code":"93976","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":876.09,"maximum":1350.51,"gross_charge":1653,"discounted_cash":378.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":876.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1350.51,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX ABD/PELV/RETRO LTD","code_information":[{"code":"93976","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":1350.51,"gross_charge":1653,"discounted_cash":378.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":606.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":606.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":828.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":621.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":621.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":876.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1350.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"93977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"US DUPLEX AORTA/IVC/GRAFT CMP","code_information":[{"code":"93978","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1069.01,"maximum":1647.89,"gross_charge":2017,"discounted_cash":461.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1069.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1647.89,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX AORTA/IVC/GRAFT CMP","code_information":[{"code":"93978","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":188.82,"maximum":1647.89,"gross_charge":2017,"discounted_cash":461.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":740.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":740.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":959.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":719.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":719.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1069.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1647.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX AORTA/IVC/GRAFT LTD","code_information":[{"code":"93979","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":341.85,"maximum":526.97,"gross_charge":645,"discounted_cash":147.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":341.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":526.97,"methodology":"fee schedule"}]}]},{"description":"US DUPLEX AORTA/IVC/GRAFT LTD","code_information":[{"code":"93979","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":113.34,"maximum":643.39,"gross_charge":645,"discounted_cash":147.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":482.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":482.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":341.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":526.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":113.34,"methodology":"fee schedule"}]}]},{"description":"PENILE VASCULAR STUDY","code_information":[{"code":"93980","type":"CPT"}],"standard_charges":[{"minimum":383.01,"maximum":383.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PENILE VASCULAR STUDY","code_information":[{"code":"93981","type":"CPT"}],"standard_charges":[{"minimum":383.01,"maximum":383.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93983","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93984","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DUP-SCAN HEMO COMPL BI STD","code_information":[{"code":"93985","type":"CPT"}],"standard_charges":[{"minimum":836.78,"maximum":836.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":836.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":836.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DUP-SCAN HEMO COMPL UNI STD","code_information":[{"code":"93986","type":"CPT"}],"standard_charges":[{"minimum":383.01,"maximum":383.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93987","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93988","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93989","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DOPPLER FLOW TESTING","code_information":[{"code":"93990","type":"CPT"}],"standard_charges":[{"minimum":383.01,"maximum":383.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":383.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93991","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93992","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93993","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93994","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93995","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93996","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"93997","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NONINVAS VASC DX STUDY PROC","code_information":[{"code":"93998","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"minimum":17600.8,"maximum":46867.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42675,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42675,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31263.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23447.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23447.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":41289.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":34049.73,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46867.23,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":17776.81,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":18128.83,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":17952.82,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":18040.82,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":17600.8,"methodology":"case rate"}]}]},{"description":"OTHER THERAPEUTIC SERVICES","code_information":[{"code":"940","type":"RC"}],"standard_charges":[{"minimum":269,"maximum":331,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":320,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":269,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":331,"methodology":"case rate"}]}]},{"description":"VENT MGNT INIT DAY INVASIVE","code_information":[{"code":"94002","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":1452.73,"maximum":2239.4,"gross_charge":2741,"discounted_cash":627.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1452.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2239.4,"methodology":"fee schedule"}]}]},{"description":"VENT MGNT INIT DAY INVASIVE","code_information":[{"code":"94002","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":95.13,"maximum":2239.4,"gross_charge":2741,"discounted_cash":627.69,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":334.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":334.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1452.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2239.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":711.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":725.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":718.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":722.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"}]}]},{"description":"VENT SUBSEQ DAY INVASIVE","code_information":[{"code":"94003","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":1452.73,"maximum":2239.4,"gross_charge":2741,"discounted_cash":627.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1452.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2239.4,"methodology":"fee schedule"}]}]},{"description":"VENT SUBSEQ DAY INVASIVE","code_information":[{"code":"94003","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":66.87,"maximum":2239.4,"gross_charge":2741,"discounted_cash":627.69,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":241.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":241.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1452.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2239.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":711.66,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":725.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":718.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":722.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":704.61,"methodology":"fee schedule"}]}]},{"description":"SPIROMETRY","code_information":[{"code":"94010","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":235.85,"maximum":363.57,"gross_charge":445,"discounted_cash":101.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":235.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":363.57,"methodology":"fee schedule"}]}]},{"description":"SPIROMETRY","code_information":[{"code":"94010","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":28.61,"maximum":363.57,"gross_charge":445,"discounted_cash":101.91,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":90.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":90.34,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":235.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":363.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"BRNCHSPASM EVAL PRE/POST","code_information":[{"code":"94060","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":354.04,"maximum":545.76,"gross_charge":668,"discounted_cash":152.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":354.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":545.76,"methodology":"fee schedule"}]}]},{"description":"BRNCHSPASM EVAL PRE/POST","code_information":[{"code":"94060","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":40.77,"maximum":545.76,"gross_charge":668,"discounted_cash":152.98,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":211.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":158.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":158.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":354.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":545.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":341.86,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":338.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":331.9,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"minimum":16385.94,"maximum":39830.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36268,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36268,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34578.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25934.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25934.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":35090.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":28937.33,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39830.34,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16385.94,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16549.8,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":16877.52,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16713.66,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16385.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16385.94,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16385.94,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16795.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16385.94,"methodology":"case rate"}]}]},{"description":"VITAL CAPACITY TOTAL","code_information":[{"code":"94150","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":174.37,"maximum":268.8,"gross_charge":329,"discounted_cash":75.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"}]}]},{"description":"VITAL CAPACITY TOTAL","code_information":[{"code":"94150","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":26.46,"maximum":268.8,"gross_charge":329,"discounted_cash":75.35,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":67.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":67.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"EDUCATION AND TRAINING","code_information":[{"code":"942","type":"RC"}],"standard_charges":[{"minimum":212,"maximum":258,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":254,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":212,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":258,"methodology":"case rate"}]}]},{"description":"CARDIAC REHAB","code_information":[{"code":"943","type":"RC"}],"standard_charges":[{"minimum":204,"maximum":244,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":244,"methodology":"case rate"}]}]},{"description":"REHABILITATION WITH CC/MCC","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"minimum":13077.75,"maximum":31872.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3494,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3494,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31872.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23904.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23904.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":26450.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21812.03,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30022.83,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":13077.75,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13208.53,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13470.09,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13339.31,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":13077.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":13077.75,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":13077.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13404.7,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":13077.75,"methodology":"case rate"}]}]},{"description":"REHABILITATION WITHOUT CC/MCC","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"minimum":9907.22,"maximum":22424.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3494,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3494,"methodology":"per diem"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16235.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12176.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12176.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19756.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16291.95,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22424.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9907.22,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10006.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10204.44,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10105.37,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9907.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9907.22,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9907.22,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10154.91,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9907.22,"methodology":"case rate"}]}]},{"description":"BLAND AERO TX INIT EA DAY","code_information":[{"code":"94640","type":"CPT"},{"code":"0412","type":"RC"}],"standard_charges":[{"minimum":196.63,"maximum":303.11,"gross_charge":371,"discounted_cash":84.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":196.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":303.11,"methodology":"fee schedule"}]}]},{"description":"BLAND AERO TX INIT EA DAY","code_information":[{"code":"94640","type":"CPT"},{"code":"0412","type":"RC"}],"standard_charges":[{"minimum":8.23,"maximum":303.11,"gross_charge":371,"discounted_cash":84.96,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":196.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":303.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":218.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":221.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":222.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"}]}]},{"description":"INH TX CONTINOUS 1ST HR","code_information":[{"code":"94644","type":"CPT"},{"code":"0412","type":"RC"}],"standard_charges":[{"minimum":312.17,"maximum":481.22,"gross_charge":589,"discounted_cash":134.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":312.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":481.22,"methodology":"fee schedule"}]}]},{"description":"INH TX CONTINOUS 1ST HR","code_information":[{"code":"94644","type":"CPT"},{"code":"0412","type":"RC"}],"standard_charges":[{"minimum":62.23,"maximum":481.22,"gross_charge":589,"discounted_cash":134.89,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":312.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":481.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.23,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"INH TX W MEDS CONT EA ADD HR","code_information":[{"code":"94645","type":"CPT"},{"code":"0412","type":"RC"}],"standard_charges":[{"minimum":255.99,"maximum":394.62,"gross_charge":483,"discounted_cash":110.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":255.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.62,"methodology":"fee schedule"}]}]},{"description":"INH TX W MEDS CONT EA ADD HR","code_information":[{"code":"94645","type":"CPT"},{"code":"0412","type":"RC"}],"standard_charges":[{"minimum":17.17,"maximum":394.62,"gross_charge":483,"discounted_cash":110.61,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":255.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"}]}]},{"description":"CPAP/BIPAP FOR OSA INIT/DAY","code_information":[{"code":"94660","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":969.37,"maximum":1494.3,"gross_charge":1829,"discounted_cash":418.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":969.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1494.3,"methodology":"fee schedule"}]}]},{"description":"CPAP/BIPAP FOR OSA INIT/DAY","code_information":[{"code":"94660","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":38.62,"maximum":1494.3,"gross_charge":1829,"discounted_cash":418.85,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":137.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":137.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":969.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1494.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":218.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":221.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":222.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"}]}]},{"description":"CPAP/BIPAP VENT SUPP INIT/DAY","code_information":[{"code":"94660","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":1020.78,"maximum":1573.55,"gross_charge":1926,"discounted_cash":441.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1020.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1573.55,"methodology":"fee schedule"}]}]},{"description":"CPAP/BIPAP VENT SUPP INIT/DAY","code_information":[{"code":"94660","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":38.62,"maximum":1573.55,"gross_charge":1926,"discounted_cash":441.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":137.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":137.17,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1020.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1573.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":218.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":221.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":222.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"}]}]},{"description":"DEMO/EVAL INHALATION TX","code_information":[{"code":"94664","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":154.76,"maximum":238.57,"gross_charge":292,"discounted_cash":66.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":154.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":238.57,"methodology":"fee schedule"}]}]},{"description":"DEMO/EVAL INHALATION TX","code_information":[{"code":"94664","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":18.6,"maximum":238.57,"gross_charge":292,"discounted_cash":66.87,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":154.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":238.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":218.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":221.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":222.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"}]}]},{"description":"MANIPULAT CHEST WALL INITIAL","code_information":[{"code":"94667","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":281.43,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"}]}]},{"description":"MANIPULAT CHEST WALL INITIAL","code_information":[{"code":"94667","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":26.11,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":75.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":75.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"MANIPULAT CHEST WALL SUBSEQNT","code_information":[{"code":"94668","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":281.43,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"}]}]},{"description":"MANIPULAT CHEST WALL SUBSEQNT","code_information":[{"code":"94668","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":41.13,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":70.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":70.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"MECHANIC CHEST WALL OSCIL/SESS","code_information":[{"code":"94669","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":284.08,"maximum":437.92,"gross_charge":536,"discounted_cash":122.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":284.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.92,"methodology":"fee schedule"}]}]},{"description":"MECHANIC CHEST WALL OSCIL/SESS","code_information":[{"code":"94669","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":21.46,"maximum":437.92,"gross_charge":536,"discounted_cash":122.75,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":121.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":121.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":284.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":218.95,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":221.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":222.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"}]}]},{"description":"SIGNS AND SYMPTOMS WITH MCC","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"minimum":9087.9,"maximum":24700.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22491,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22491,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12116.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9087.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9087.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":21760.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17945.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24700.29,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":11219.51,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":11331.71,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":11556.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":11443.91,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":11219.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":11219.51,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":11219.51,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":11500,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":11219.51,"methodology":"case rate"}]}]},{"description":"PULSE OX SINGLE DETERM","code_information":[{"code":"94760","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":111.83,"maximum":172.39,"gross_charge":211,"discounted_cash":48.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"}]}]},{"description":"PULSE OX SINGLE DETERM","code_information":[{"code":"94760","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":2.86,"maximum":172.39,"gross_charge":211,"discounted_cash":48.32,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":111.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"}]}]},{"description":"PULSE OX MULTI W EXERCISE","code_information":[{"code":"94761","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":174.37,"maximum":268.8,"gross_charge":329,"discounted_cash":75.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"}]}]},{"description":"PULSE OX MULTI W EXERCISE","code_information":[{"code":"94761","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":4.29,"maximum":268.8,"gross_charge":329,"discounted_cash":75.35,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":174.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"}]}]},{"description":"PULSE OX CONTINUOUS OVERNIGHT","code_information":[{"code":"94762","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":871.85,"maximum":1343.97,"gross_charge":1645,"discounted_cash":376.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":871.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.97,"methodology":"fee schedule"}]}]},{"description":"PULSE OX CONTINUOUS OVERNIGHT","code_information":[{"code":"94762","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":26.46,"maximum":1343.97,"gross_charge":1645,"discounted_cash":376.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":107.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":107.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":871.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":168.43,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":166.76,"methodology":"fee schedule"}]}]},{"description":"PULMONARY REHAB","code_information":[{"code":"948","type":"RC"}],"standard_charges":[{"minimum":210,"maximum":244,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":210,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":244,"methodology":"case rate"}]}]},{"description":"SIGNS AND SYMPTOMS WITHOUT MCC","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":6935.98,"maximum":16083.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14644,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14644,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9247.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6935.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6935.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":14169.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11684.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16083.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":7417.18,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7491.36,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7639.7,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7565.53,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":7417.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":7417.18,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":7417.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7602.61,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":7417.18,"methodology":"case rate"}]}]},{"description":"AFTERCARE WITH CC/MCC","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"minimum":5632.89,"maximum":22464,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20454,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20454,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7510.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5632.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5632.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":19790.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":16320.43,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22464,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9617.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9713.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9905.75,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9809.58,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9617.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9617.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9617.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9857.67,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9617.23,"methodology":"case rate"}]}]},{"description":"OTHER THERAPEUTIC SERVICES","code_information":[{"code":"949","type":"RC"}],"standard_charges":[{"minimum":269,"maximum":331,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":320,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":269,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":331,"methodology":"case rate"}]}]},{"description":"AFTERCARE WITHOUT CC/MCC","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"minimum":5805.62,"maximum":15284.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13917,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13917,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10376.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7782.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7782.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":13465.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11104.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15284.76,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5805.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5863.68,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5979.79,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5921.74,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5805.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5805.62,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5805.62,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5950.77,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5805.62,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9501","type":"APR-DRG"}],"standard_charges":[{"minimum":9093,"maximum":9093,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9093,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9093,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9093,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9502","type":"APR-DRG"}],"standard_charges":[{"minimum":13113,"maximum":13113,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13113,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13113,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13113,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9503","type":"APR-DRG"}],"standard_charges":[{"minimum":19659,"maximum":19659,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19659,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19659,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19659,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9504","type":"APR-DRG"}],"standard_charges":[{"minimum":37722,"maximum":37722,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37722,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37722,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37722,"methodology":"case rate"}]}]},{"description":"OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"minimum":5657.92,"maximum":153640.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11017,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11017,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153640.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":115232.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":115232.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":10659.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":8790.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12099.49,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5657.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5714.5,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5827.66,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5771.08,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5657.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5657.92,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5657.92,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5799.37,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5657.92,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9511","type":"APR-DRG"}],"standard_charges":[{"minimum":6588,"maximum":6588,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6588,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6588,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9512","type":"APR-DRG"}],"standard_charges":[{"minimum":9570,"maximum":9570,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9570,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9570,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9570,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9513","type":"APR-DRG"}],"standard_charges":[{"minimum":14944,"maximum":14944,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14944,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14944,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14944,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9514","type":"APR-DRG"}],"standard_charges":[{"minimum":28299,"maximum":28299,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28299,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28299,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28299,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9521","type":"APR-DRG"}],"standard_charges":[{"minimum":5755,"maximum":5755,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5755,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5755,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5755,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9522","type":"APR-DRG"}],"standard_charges":[{"minimum":8063,"maximum":8063,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8063,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8063,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8063,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9523","type":"APR-DRG"}],"standard_charges":[{"minimum":13205,"maximum":13205,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13205,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13205,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13205,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9524","type":"APR-DRG"}],"standard_charges":[{"minimum":26155,"maximum":26155,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26155,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26155,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26155,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"minimum":54076.67,"maximum":140660.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114222,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114222,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95191.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":71394.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":71394.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":122959.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":91134.53,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":140660.2,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":54076.67,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":54617.44,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":55698.98,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":55158.21,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":54076.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":54076.67,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":54076.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":55428.59,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":54076.67,"methodology":"case rate"}]}]},{"description":"LIMB REATTACHMENT HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"minimum":30831.99,"maximum":123568.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73699,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73699,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123568.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":92677.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":92677.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":71305.97,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":58802.42,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":80937.67,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":30831.99,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31140.31,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":31756.95,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31448.63,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":30831.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":30831.99,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":30831.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":31602.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":30831.99,"methodology":"case rate"}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"minimum":58994.1,"maximum":174277.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141520,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141520,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95482.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":71612.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":71612.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":152346.48,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":112915.09,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":174277.08,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":58994.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":59584.05,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":60763.93,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":60173.99,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":58994.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":58994.1,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":58994.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":60468.96,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":58994.1,"methodology":"case rate"}]}]},{"description":"POLYSOM <6 YRS 4/> PARAMTRS","code_information":[{"code":"95782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POLYSOM <6 YRS CPAP/BILVL","code_information":[{"code":"95783","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"minimum":33054.46,"maximum":96948.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78726,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78726,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78855.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59142.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59142.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":84748.37,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":62813.2,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":96948.08,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":33054.46,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":33385.01,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":34046.1,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":33715.55,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":33054.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":33054.46,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":33054.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":33880.83,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":33054.46,"methodology":"case rate"}]}]},{"description":"SLP STDY UNATTENDED","code_information":[{"code":"95800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SLP STDY UNATND W/ANAL","code_information":[{"code":"95801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MULTIPLE SLEEP LATENCY TEST","code_information":[{"code":"95805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SLEEP STUDY UNATT&RESP EFFT","code_information":[{"code":"95806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SLEEP STUDY ATTENDED","code_information":[{"code":"95807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POLYSOM ANY AGE 1-3> PARAM","code_information":[{"code":"95808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POLYSOM 6/> YRS 4/> PARAM","code_information":[{"code":"95810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POLYSOM 6/>YRS CPAP 4/> PARM","code_information":[{"code":"95811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"minimum":21718.63,"maximum":64783.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52607,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52607,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52582.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39437.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39437.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":56631.71,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":41973.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64783.96,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21718.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":21935.82,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22370.19,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22153.01,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21718.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21718.63,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21718.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22261.6,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21718.63,"methodology":"case rate"}]}]},{"description":"ANALYSIS NEUROSTIM WO PROGRAM","code_information":[{"code":"95970","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":253.87,"maximum":391.35,"gross_charge":479,"discounted_cash":109.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":253.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":391.35,"methodology":"fee schedule"}]}]},{"description":"ANALYSIS NEUROSTIM WO PROGRAM","code_information":[{"code":"95970","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":391.35,"gross_charge":479,"discounted_cash":109.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":83.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":83.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":253.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":391.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.76,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.38,"methodology":"fee schedule"}]}]},{"description":"CANALITH REPOS PER DAY","code_information":[{"code":"95992","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":168.01,"maximum":258.99,"gross_charge":317,"discounted_cash":72.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":168.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.99,"methodology":"fee schedule"}]}]},{"description":"CANALITH REPOS PER DAY","code_information":[{"code":"95992","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":37.55,"maximum":258.99,"gross_charge":317,"discounted_cash":72.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":108.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":108.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":168.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"}]}]},{"description":"PT REPOSITIONING CANALITH PROC","code_information":[{"code":"95992","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":186.56,"maximum":287.59,"gross_charge":352,"discounted_cash":80.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":186.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":287.59,"methodology":"fee schedule"}]}]},{"description":"PT REPOSITIONING CANALITH PROC","code_information":[{"code":"95992","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":37.55,"maximum":287.59,"gross_charge":352,"discounted_cash":80.61,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":108.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":108.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":186.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":287.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"}]}]},{"description":"ST ASSESS APHASIA PER HR","code_information":[{"code":"96105","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":172.78,"maximum":266.35,"gross_charge":326,"discounted_cash":74.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":172.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":266.35,"methodology":"fee schedule"}]}]},{"description":"ST ASSESS APHASIA PER HR","code_information":[{"code":"96105","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":101.56,"maximum":358.23,"gross_charge":326,"discounted_cash":74.66,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":358.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":268.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":268.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":172.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":266.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.56,"methodology":"fee schedule"}]}]},{"description":"ST TEST STD PERFRM COG EA HR","code_information":[{"code":"96125","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":303.16,"maximum":467.33,"gross_charge":572,"discounted_cash":130.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":303.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":467.33,"methodology":"fee schedule"}]}]},{"description":"ST TEST STD PERFRM COG EA HR","code_information":[{"code":"96125","type":"CPT"},{"code":"0444","type":"RC"}],"standard_charges":[{"minimum":108.36,"maximum":467.33,"gross_charge":572,"discounted_cash":130.99,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":407.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":305.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":305.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":303.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":467.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.36,"methodology":"fee schedule"}]}]},{"description":"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"minimum":22281.59,"maximum":56218.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51191,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51191,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38925.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29194.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29194.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":49528.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":40843.79,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":56218.81,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22281.59,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22504.41,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22950.04,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22727.23,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22281.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22281.59,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22281.59,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22838.63,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22281.59,"methodology":"case rate"}]}]},{"description":"INF IV HYDRA INIT 31-60MN","code_information":[{"code":"96360","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":181.79,"maximum":280.24,"gross_charge":343,"discounted_cash":78.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":181.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":280.24,"methodology":"fee schedule"}]}]},{"description":"INF IV HYDRA INIT 31-60MN","code_information":[{"code":"96360","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":33.97,"maximum":280.24,"gross_charge":343,"discounted_cash":78.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.1,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":278.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":209.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":209.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":181.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":280.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":226.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":231.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":229.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":230.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"}]}]},{"description":"INF IV HYDRAT EA ADD HR","code_information":[{"code":"96361","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":169.6,"maximum":261.44,"gross_charge":320,"discounted_cash":73.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":169.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.44,"methodology":"fee schedule"}]}]},{"description":"INF IV HYDRAT EA ADD HR","code_information":[{"code":"96361","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":12.87,"maximum":261.44,"gross_charge":320,"discounted_cash":73.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.56,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.56,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":169.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":50.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"}]}]},{"description":"INF TX/DX/PRO INIT 1ST HR","code_information":[{"code":"96365","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":485.48,"maximum":748.38,"gross_charge":916,"discounted_cash":209.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":485.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":748.38,"methodology":"fee schedule"}]}]},{"description":"INF TX/DX/PRO INIT 1ST HR","code_information":[{"code":"96365","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":65.44,"maximum":748.38,"gross_charge":916,"discounted_cash":209.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":419.53,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":419.53,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":339.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":254.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":254.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":485.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":748.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":226.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":231.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":229.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":230.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"}]}]},{"description":"INF TX/DX/PRO EA ADD HR","code_information":[{"code":"96366","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":169.6,"maximum":261.44,"gross_charge":320,"discounted_cash":73.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":169.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.44,"methodology":"fee schedule"}]}]},{"description":"INF TX/DX/PRO EA ADD HR","code_information":[{"code":"96366","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":21.46,"maximum":261.44,"gross_charge":320,"discounted_cash":73.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.56,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.56,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":169.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":50.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"}]}]},{"description":"INF TX/DX/PRO SEQ 1HR","code_information":[{"code":"96367","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":346.09,"maximum":533.51,"gross_charge":653,"discounted_cash":149.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":346.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":533.51,"methodology":"fee schedule"}]}]},{"description":"INF TX/DX/PRO SEQ 1HR","code_information":[{"code":"96367","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":533.51,"gross_charge":653,"discounted_cash":149.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.08,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.08,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":128.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":128.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":346.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":533.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":76.61,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":78.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":77.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":77.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"}]}]},{"description":"INF TX/DX CONCURRENT","code_information":[{"code":"96368","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":181.26,"maximum":279.42,"gross_charge":342,"discounted_cash":78.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":181.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":279.42,"methodology":"fee schedule"}]}]},{"description":"INF TX/DX CONCURRENT","code_information":[{"code":"96368","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":20.74,"maximum":279.42,"gross_charge":342,"discounted_cash":78.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.64,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":181.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":279.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.74,"methodology":"fee schedule"}]}]},{"description":"INJ TX/DX/PROPH SUBQ/IM","code_information":[{"code":"96372","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":266.59,"maximum":410.96,"gross_charge":503,"discounted_cash":115.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.96,"methodology":"fee schedule"}]}]},{"description":"INJ TX/DX/PROPH SUBQ/IM","code_information":[{"code":"96372","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":15.02,"maximum":410.96,"gross_charge":503,"discounted_cash":115.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.38,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":76.61,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":78.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":77.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":77.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"}]}]},{"description":"INJ TX/DX/PRO INTRA-ARTER","code_information":[{"code":"96373","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":466.4,"maximum":718.96,"gross_charge":880,"discounted_cash":201.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":466.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":718.96,"methodology":"fee schedule"}]}]},{"description":"INJ TX/DX/PRO INTRA-ARTER","code_information":[{"code":"96373","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":19.67,"maximum":718.96,"gross_charge":880,"discounted_cash":201.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":403.04,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":403.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":67.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":67.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":466.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":718.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":226.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":231.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":229.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":230.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"}]}]},{"description":"INJ TX/DX/PRO IVPUSH INIT","code_information":[{"code":"96374","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":285.14,"maximum":439.55,"gross_charge":538,"discounted_cash":123.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":285.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":439.55,"methodology":"fee schedule"}]}]},{"description":"INJ TX/DX/PRO IVPUSH INIT","code_information":[{"code":"96374","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":38.27,"maximum":439.55,"gross_charge":538,"discounted_cash":123.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.41,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":201.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":201.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":285.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":439.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":226.81,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":231.3,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":229.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":230.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":224.56,"methodology":"fee schedule"}]}]},{"description":"INJ TX/DX/PRO IV PUSH SEQ","code_information":[{"code":"96375","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":266.59,"maximum":410.96,"gross_charge":503,"discounted_cash":115.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.96,"methodology":"fee schedule"}]}]},{"description":"INJ TX/DX/PRO IV PUSH SEQ","code_information":[{"code":"96375","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":16.09,"maximum":410.96,"gross_charge":503,"discounted_cash":115.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.38,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.38,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":87.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":87.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":50.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"}]}]},{"description":"INJ TX/PRO/DX IVP SME DRG","code_information":[{"code":"96376","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":266.59,"maximum":410.96,"gross_charge":503,"discounted_cash":115.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.96,"methodology":"fee schedule"}]}]},{"description":"INJ TX/PRO/DX IVP SME DRG","code_information":[{"code":"96376","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":70.42,"maximum":410.96,"gross_charge":503,"discounted_cash":115.19,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":87.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":87.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":266.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"}]}]},{"description":"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"minimum":12873.6,"maximum":32273.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28055,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28055,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32273.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":24205.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":24205.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":27144.36,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":22384.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30810.9,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12873.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":13002.34,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":13259.81,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":13131.08,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12873.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12873.6,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12873.6,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":13195.44,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12873.6,"methodology":"case rate"}]}]},{"description":"CHEMO SQ/IM NONHORMONAL","code_information":[{"code":"96401","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":146.28,"maximum":225.5,"gross_charge":276,"discounted_cash":63.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"}]}]},{"description":"CHEMO SQ/IM NONHORMONAL","code_information":[{"code":"96401","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":75.1,"maximum":333.95,"gross_charge":276,"discounted_cash":63.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.41,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":250.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":250.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":76.61,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":78.13,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":77.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":77.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"}]}]},{"description":"OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"minimum":8330.45,"maximum":108817.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17227,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17227,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108817.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81614.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81614.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16668.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13745.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18919.77,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8330.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8413.76,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8580.37,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8497.06,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8330.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8330.45,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8330.45,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8538.72,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8330.45,"methodology":"case rate"}]}]},{"description":"HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"minimum":50179.23,"maximum":119709.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109003,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109003,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78021.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58517.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58517.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":105464.07,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":86970.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":119709.7,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":50179.23,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":50681.03,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":51684.61,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":51182.82,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":50179.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":50179.23,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":50179.23,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":51433.72,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":50179.23,"methodology":"case rate"}]}]},{"description":"HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"minimum":21791.32,"maximum":60177.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54795,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54795,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58470.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":43853.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":43853.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":53016.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":43719.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":60177.71,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":21791.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22009.24,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22445.06,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22227.15,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":21791.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":21791.32,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":21791.32,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22336.11,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":21791.32,"methodology":"case rate"}]}]},{"description":"PT VASOPNEUMATIC DEVICE","code_information":[{"code":"97016","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":54.59,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"}]}]},{"description":"PT VASOPNEUMATIC DEVICE","code_information":[{"code":"97016","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":12.16,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":47.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":47.69,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"}]}]},{"description":"OT APPL E-STIM>=1 MODALITY15EA","code_information":[{"code":"97032","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":90.1,"maximum":138.89,"gross_charge":170,"discounted_cash":38.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.89,"methodology":"fee schedule"}]}]},{"description":"OT APPL E-STIM>=1 MODALITY15EA","code_information":[{"code":"97032","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":15.02,"maximum":138.89,"gross_charge":170,"discounted_cash":38.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":51.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":51.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"}]}]},{"description":"PT APPL E-STIM>=1 MODALITY15EA","code_information":[{"code":"97032","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":90.1,"maximum":138.89,"gross_charge":170,"discounted_cash":38.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.89,"methodology":"fee schedule"}]}]},{"description":"PT APPL E-STIM>=1 MODALITY15EA","code_information":[{"code":"97032","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":15.02,"maximum":138.89,"gross_charge":170,"discounted_cash":38.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":51.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":51.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"}]}]},{"description":"PT CONTRAST BATH EA 15","code_information":[{"code":"97034","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":59.36,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"}]}]},{"description":"PT CONTRAST BATH EA 15","code_information":[{"code":"97034","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":14.66,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.71,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"}]}]},{"description":"OT EXERCISE THR EA 15","code_information":[{"code":"97110","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":140.45,"maximum":216.51,"gross_charge":265,"discounted_cash":60.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":216.51,"methodology":"fee schedule"}]}]},{"description":"OT EXERCISE THR EA 15","code_information":[{"code":"97110","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":31.11,"maximum":216.51,"gross_charge":265,"discounted_cash":60.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":216.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"}]}]},{"description":"PT EXERCISE THR EA 15","code_information":[{"code":"97110","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":140.45,"maximum":216.51,"gross_charge":265,"discounted_cash":60.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":216.51,"methodology":"fee schedule"}]}]},{"description":"PT EXERCISE THR EA 15","code_information":[{"code":"97110","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":31.11,"maximum":216.51,"gross_charge":265,"discounted_cash":60.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":216.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"}]}]},{"description":"OT RE-ED NEUROMSCL EA 15","code_information":[{"code":"97112","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":115.54,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"OT RE-ED NEUROMSCL EA 15","code_information":[{"code":"97112","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":35.76,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"}]}]},{"description":"PT RE-ED NEUROMSCL EA 15","code_information":[{"code":"97112","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":115.54,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"PT RE-ED NEUROMSCL EA 15","code_information":[{"code":"97112","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":35.76,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":76.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":76.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"}]}]},{"description":"PT TRAINING GAIT EA 15","code_information":[{"code":"97116","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":108.12,"maximum":166.67,"gross_charge":204,"discounted_cash":46.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"}]}]},{"description":"PT TRAINING GAIT EA 15","code_information":[{"code":"97116","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":31.11,"maximum":166.67,"gross_charge":204,"discounted_cash":46.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":65.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":65.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"}]}]},{"description":"OT MASSAGE EA 15","code_information":[{"code":"97124","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":66.78,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"}]}]},{"description":"OT MASSAGE EA 15","code_information":[{"code":"97124","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":31.83,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"}]}]},{"description":"PT MASSAGE EA 15","code_information":[{"code":"97124","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":66.78,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"}]}]},{"description":"PT MASSAGE EA 15","code_information":[{"code":"97124","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":31.83,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"}]}]},{"description":"OT THER INTV COGN SK INIT 15MN","code_information":[{"code":"97129","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":83.74,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"}]}]},{"description":"OT THER INTV COGN SK INIT 15MN","code_information":[{"code":"97129","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":23.25,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"}]}]},{"description":"ST THER INTV COGN SK INIT 15MN","code_information":[{"code":"97129","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":91.69,"maximum":141.35,"gross_charge":173,"discounted_cash":39.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.35,"methodology":"fee schedule"}]}]},{"description":"ST THER INTV COGN SK INIT 15MN","code_information":[{"code":"97129","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":23.25,"maximum":141.35,"gross_charge":173,"discounted_cash":39.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"}]}]},{"description":"OT THER INTV EA ADDL 15MN","code_information":[{"code":"97130","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":91.69,"maximum":141.35,"gross_charge":173,"discounted_cash":39.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.35,"methodology":"fee schedule"}]}]},{"description":"OT THER INTV EA ADDL 15MN","code_information":[{"code":"97130","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":22.53,"maximum":141.35,"gross_charge":173,"discounted_cash":39.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"}]}]},{"description":"ST THER INTV EA ADDL 15MN","code_information":[{"code":"97130","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":83.74,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"}]}]},{"description":"ST THER INTV EA ADDL 15MN","code_information":[{"code":"97130","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":22.53,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY MANUAL EA 15","code_information":[{"code":"97140","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":104.94,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY MANUAL EA 15","code_information":[{"code":"97140","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":28.61,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY MANUAL EA 15","code_information":[{"code":"97140","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":104.94,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY MANUAL EA 15","code_information":[{"code":"97140","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":28.61,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.61,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 15","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":62.54,"maximum":96.41,"gross_charge":118,"discounted_cash":27.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.41,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 15","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":96.41,"gross_charge":118,"discounted_cash":27.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 30","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":70.49,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 30","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 45","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":78.97,"maximum":121.74,"gross_charge":149,"discounted_cash":34.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 45","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":121.74,"gross_charge":149,"discounted_cash":34.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 60","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":90.63,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 60","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 75","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":102.29,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 75","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 90","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":115.01,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"}]}]},{"description":"OT THERAPY GROUP 90","code_information":[{"code":"97150","type":"CPT"},{"code":"0433","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 15","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":62.54,"maximum":96.41,"gross_charge":118,"discounted_cash":27.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.41,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 15","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":96.41,"gross_charge":118,"discounted_cash":27.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 30","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":70.49,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 30","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 45","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":78.97,"maximum":121.74,"gross_charge":149,"discounted_cash":34.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 45","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":121.74,"gross_charge":149,"discounted_cash":34.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 60","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":90.63,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 60","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 75","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":102.29,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 75","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":157.69,"gross_charge":193,"discounted_cash":44.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":102.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 90","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":115.01,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"}]}]},{"description":"PT THERAPY GROUP 90","code_information":[{"code":"97150","type":"CPT"},{"code":"0423","type":"RC"}],"standard_charges":[{"minimum":18.95,"maximum":177.29,"gross_charge":217,"discounted_cash":49.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"PT EVAL LOW COMPLEXITY","code_information":[{"code":"97161","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":281.43,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"}]}]},{"description":"PT EVAL LOW COMPLEXITY","code_information":[{"code":"97161","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":106.21,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":249.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":249.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"}]}]},{"description":"PT EVAL MODERATE COMPLEXITY","code_information":[{"code":"97162","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":281.43,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"}]}]},{"description":"PT EVAL MODERATE COMPLEXITY","code_information":[{"code":"97162","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":106.21,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":249.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":249.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"}]}]},{"description":"PT EVAL HIGH COMPLEXITY","code_information":[{"code":"97163","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":281.43,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"}]}]},{"description":"PT EVAL HIGH COMPLEXITY","code_information":[{"code":"97163","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":106.21,"maximum":433.83,"gross_charge":531,"discounted_cash":121.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":249.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":249.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":281.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"}]}]},{"description":"PT RE-EVAL EST CARE PLAN","code_information":[{"code":"97164","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":186.03,"maximum":286.77,"gross_charge":351,"discounted_cash":80.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":186.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":286.77,"methodology":"fee schedule"}]}]},{"description":"PT RE-EVAL EST CARE PLAN","code_information":[{"code":"97164","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":286.77,"gross_charge":351,"discounted_cash":80.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":169.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":169.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":186.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":286.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"}]}]},{"description":"OT EVAL LOW COMPLEXITY","code_information":[{"code":"97165","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":283.02,"maximum":436.28,"gross_charge":534,"discounted_cash":122.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.28,"methodology":"fee schedule"}]}]},{"description":"OT EVAL LOW COMPLEXITY","code_information":[{"code":"97165","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":107.29,"maximum":436.28,"gross_charge":534,"discounted_cash":122.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":321.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":321.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":241.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":241.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"}]}]},{"description":"OT EVAL MODERATE COMPLEXITY","code_information":[{"code":"97166","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":283.02,"maximum":436.28,"gross_charge":534,"discounted_cash":122.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.28,"methodology":"fee schedule"}]}]},{"description":"OT EVAL MODERATE COMPLEXITY","code_information":[{"code":"97166","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":107.29,"maximum":436.28,"gross_charge":534,"discounted_cash":122.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":321.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":321.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":241.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":241.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"}]}]},{"description":"OT EVAL HIGH COMPLEXITY","code_information":[{"code":"97167","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":283.02,"maximum":436.28,"gross_charge":534,"discounted_cash":122.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.28,"methodology":"fee schedule"}]}]},{"description":"OT EVAL HIGH COMPLEXITY","code_information":[{"code":"97167","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":107.29,"maximum":436.28,"gross_charge":534,"discounted_cash":122.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":321.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":321.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":241.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":241.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"}]}]},{"description":"OT RE-EVAL EST CARE PLAN","code_information":[{"code":"97168","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":195.57,"maximum":301.48,"gross_charge":369,"discounted_cash":84.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":195.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":301.48,"methodology":"fee schedule"}]}]},{"description":"OT RE-EVAL EST CARE PLAN","code_information":[{"code":"97168","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":74.03,"maximum":301.48,"gross_charge":369,"discounted_cash":84.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":212.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":159.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":159.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":195.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":301.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.03,"methodology":"fee schedule"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITH MCC","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"minimum":24365.64,"maximum":55162.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50229,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50229,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43529,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32647.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32647.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":48598.13,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":40076.41,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":55162.55,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24365.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24609.3,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":25096.61,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24852.96,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24365.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24365.64,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24365.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24974.79,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24365.64,"methodology":"case rate"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITH CC","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"minimum":12265.01,"maximum":36527.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25209,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25209,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36527.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27396.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27396.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":24390.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":20113.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27685.46,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12265.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12387.67,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12632.97,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12510.32,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12265.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12265.01,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12265.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12571.64,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12265.01,"methodology":"case rate"}]}]},{"description":"OT THR ACTIVITY EA 15","code_information":[{"code":"97530","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":118.72,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"}]}]},{"description":"OT THR ACTIVITY EA 15","code_information":[{"code":"97530","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":38.62,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"}]}]},{"description":"PT THR ACTIVITY EA 15","code_information":[{"code":"97530","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":118.72,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"}]}]},{"description":"PT THR ACTIVITY EA 15","code_information":[{"code":"97530","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":38.62,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"}]}]},{"description":"OT TRAIN SELF CARE/HOME EA 15","code_information":[{"code":"97535","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":110.24,"maximum":169.94,"gross_charge":208,"discounted_cash":47.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":110.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.94,"methodology":"fee schedule"}]}]},{"description":"OT TRAIN SELF CARE/HOME EA 15","code_information":[{"code":"97535","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":34.69,"maximum":169.94,"gross_charge":208,"discounted_cash":47.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":110.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"}]}]},{"description":"PT TRAIN SELF CARE/HOME EA 15","code_information":[{"code":"97535","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":110.24,"maximum":169.94,"gross_charge":208,"discounted_cash":47.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":110.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.94,"methodology":"fee schedule"}]}]},{"description":"PT TRAIN SELF CARE/HOME EA 15","code_information":[{"code":"97535","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":34.69,"maximum":169.94,"gross_charge":208,"discounted_cash":47.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":78.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":78.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":110.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.69,"methodology":"fee schedule"}]}]},{"description":"OT MANAGEMENT WHEELCHAIR EA 15","code_information":[{"code":"97542","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":101.23,"maximum":156.05,"gross_charge":191,"discounted_cash":43.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.05,"methodology":"fee schedule"}]}]},{"description":"OT MANAGEMENT WHEELCHAIR EA 15","code_information":[{"code":"97542","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":33.62,"maximum":156.05,"gross_charge":191,"discounted_cash":43.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":71.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":71.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"}]}]},{"description":"PT MANAGEMENT WHEELCHAIR EA 15","code_information":[{"code":"97542","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":101.23,"maximum":156.05,"gross_charge":191,"discounted_cash":43.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.05,"methodology":"fee schedule"}]}]},{"description":"PT MANAGEMENT WHEELCHAIR EA 15","code_information":[{"code":"97542","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":33.62,"maximum":156.05,"gross_charge":191,"discounted_cash":43.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":71.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":71.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"}]}]},{"description":"OT CAREGIVER TRAIN INIT 30 MIN","code_information":[{"code":"97550","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":94.87,"maximum":146.25,"gross_charge":179,"discounted_cash":41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"}]}]},{"description":"OT CAREGIVER TRAIN INIT 30 MIN","code_information":[{"code":"97550","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":94.87,"maximum":267.92,"gross_charge":179,"discounted_cash":41,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":200.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":200.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"}]}]},{"description":"PT CAREGIVER TRAIN INIT 30 MIN","code_information":[{"code":"97550","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":94.87,"maximum":146.25,"gross_charge":179,"discounted_cash":41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"}]}]},{"description":"PT CAREGIVER TRAIN INIT 30 MIN","code_information":[{"code":"97550","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":94.87,"maximum":267.92,"gross_charge":179,"discounted_cash":41,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":200.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":200.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"}]}]},{"description":"ST CAREGIVER TRAIN INIT 30 MIN","code_information":[{"code":"97550","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":94.87,"maximum":146.25,"gross_charge":179,"discounted_cash":41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"}]}]},{"description":"ST CAREGIVER TRAIN INIT 30 MIN","code_information":[{"code":"97550","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":94.87,"maximum":267.92,"gross_charge":179,"discounted_cash":41,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":200.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":200.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"}]}]},{"description":"DEBR SELECTIVE SESSION 1ST20CM","code_information":[{"code":"97597","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":280.37,"maximum":432.2,"gross_charge":529,"discounted_cash":121.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":280.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":432.2,"methodology":"fee schedule"}]}]},{"description":"DEBR SELECTIVE SESSION 1ST20CM","code_information":[{"code":"97597","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":37.19,"maximum":432.2,"gross_charge":529,"discounted_cash":121.15,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":297.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":280.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":432.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"DEBR SELCT SESSION EA ADD 20CM","code_information":[{"code":"97598","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":379.48,"maximum":584.98,"gross_charge":716,"discounted_cash":163.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":379.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":584.98,"methodology":"fee schedule"}]}]},{"description":"DEBR SELCT SESSION EA ADD 20CM","code_information":[{"code":"97598","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":25.75,"maximum":584.98,"gross_charge":716,"discounted_cash":163.97,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":379.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":584.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"minimum":9029.52,"maximum":22074.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17173,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17173,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22074.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16556.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16556.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":16615.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":13702.02,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18859.94,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9029.52,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9119.82,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9300.41,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9210.12,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9029.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9029.52,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9029.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9255.26,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9029.52,"methodology":"case rate"}]}]},{"description":"DEBRIDE NON-SELECTIVE SESSION","code_information":[{"code":"97602","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":235.32,"maximum":362.75,"gross_charge":444,"discounted_cash":101.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":235.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":362.75,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE NON-SELECTIVE SESSION","code_information":[{"code":"97602","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":133.42,"maximum":362.75,"gross_charge":444,"discounted_cash":101.68,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":235.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":362.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"NEG PRESSURE WOUND DME<=50SQCM","code_information":[{"code":"97605","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":392.2,"maximum":604.58,"gross_charge":740,"discounted_cash":169.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":392.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":604.58,"methodology":"fee schedule"}]}]},{"description":"NEG PRESSURE WOUND DME<=50SQCM","code_information":[{"code":"97605","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":25.39,"maximum":604.58,"gross_charge":740,"discounted_cash":169.46,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":392.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":604.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":216.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":217.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":211.78,"methodology":"fee schedule"}]}]},{"description":"NEG PRESSURE WOUND DME>50SQCM","code_information":[{"code":"97606","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":809.84,"maximum":1248.38,"gross_charge":1528,"discounted_cash":349.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":809.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1248.38,"methodology":"fee schedule"}]}]},{"description":"NEG PRESSURE WOUND DME>50SQCM","code_information":[{"code":"97606","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":27.89,"maximum":1248.38,"gross_charge":1528,"discounted_cash":349.92,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":162.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":809.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1248.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":430.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":438.61,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":434.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":436.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":425.83,"methodology":"fee schedule"}]}]},{"description":"HIV WITH OR WITHOUT OTHER RELATED CONDITION","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"minimum":12423.54,"maximum":80824.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24429,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24429,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80824.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":60619.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":60619.72,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":23636.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":19491.89,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26829.31,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":12423.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":12547.78,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":12796.25,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":12672.02,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":12423.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":12423.54,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":12423.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":12734.13,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":12423.54,"methodology":"case rate"}]}]},{"description":"OT MNGMT/TRAIN ORTH INIT EA 15","code_information":[{"code":"97760","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":65.19,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"}]}]},{"description":"OT MNGMT/TRAIN ORTH INIT EA 15","code_information":[{"code":"97760","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":50.42,"maximum":134.98,"gross_charge":123,"discounted_cash":28.17,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"}]}]},{"description":"PT MNGMT/TRAIN ORTH INIT EA 15","code_information":[{"code":"97760","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":64.13,"maximum":98.86,"gross_charge":121,"discounted_cash":27.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.86,"methodology":"fee schedule"}]}]},{"description":"PT MNGMT/TRAIN ORTH INIT EA 15","code_information":[{"code":"97760","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":50.42,"maximum":134.98,"gross_charge":121,"discounted_cash":27.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.42,"methodology":"fee schedule"}]}]},{"description":"PT TRAIN PROSTH INITIAL EA 15","code_information":[{"code":"97761","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"PT TRAIN PROSTH INITIAL EA 15","code_information":[{"code":"97761","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":43.99,"maximum":120.32,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":90.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":90.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"}]}]},{"description":"OT MNG/TRN ORTH/PROS SUB EA15","code_information":[{"code":"97763","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":144.69,"maximum":223.05,"gross_charge":273,"discounted_cash":62.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.05,"methodology":"fee schedule"}]}]},{"description":"OT MNG/TRN ORTH/PROS SUB EA15","code_information":[{"code":"97763","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":55.07,"maximum":223.05,"gross_charge":273,"discounted_cash":62.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.07,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"minimum":38035.3,"maximum":92643.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84357,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84357,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60584.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45439.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45439.48,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":81618.47,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":67306.61,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":92643.14,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":38035.3,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":38415.66,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":39176.36,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":38796.01,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":38035.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":38035.3,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":38035.3,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":38986.19,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":38035.3,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"minimum":20206.05,"maximum":50298,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45799,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45799,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45470.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":34103.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":34103.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":44312.46,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":36542.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50298,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":20206.05,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":20408.12,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":20812.24,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":20610.18,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":20206.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":20206.05,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":20206.05,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":20711.21,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":20206.05,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"minimum":14173.52,"maximum":52288.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30752,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30752,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52288.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39217.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39217.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":29754.29,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":24536.85,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33773.37,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14173.52,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14315.26,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14598.73,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14457,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14173.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14173.52,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14173.52,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14527.86,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14173.52,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"minimum":27704.97,"maximum":68774.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62623,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62623,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36939.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27704.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27704.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":60589.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":49965.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68774.23,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":28359.75,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":28643.35,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":29210.55,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":28926.95,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":28359.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":28359.75,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":28359.75,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":29068.75,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":28359.75,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"minimum":14543.16,"maximum":35448.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32278,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32278,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29923.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22443.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22443.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":31230.1,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":25753.88,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35448.52,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":14543.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":14688.6,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":14979.46,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":14834.03,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":14543.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":14543.16,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":14543.16,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":14906.74,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":14543.16,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"minimum":10208.8,"maximum":23774.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21647,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21647,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":20944.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":17272.17,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23774.01,"methodology":"case rate"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":10208.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":10310.89,"methodology":"case rate"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10515.07,"methodology":"case rate"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":10412.98,"methodology":"case rate"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":10208.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":10208.8,"methodology":"case rate"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":10208.8,"methodology":"case rate"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":10464.02,"methodology":"case rate"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":10208.8,"methodology":"case rate"}]}]},{"description":"PRIVATE DUTY NURSE","code_information":[{"code":"989","type":"RC"}],"standard_charges":[{"minimum":148.3,"maximum":197.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MOD SEDAT <5YRS 1ST 15M","code_information":[{"code":"99151","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":420.29,"maximum":647.89,"gross_charge":793,"discounted_cash":181.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.89,"methodology":"fee schedule"}]}]},{"description":"MOD SEDAT <5YRS 1ST 15M","code_information":[{"code":"99151","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":25.03,"maximum":647.89,"gross_charge":793,"discounted_cash":181.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.03,"methodology":"fee schedule"}]}]},{"description":"MOD SEDAT =>5YRS 1ST 15M","code_information":[{"code":"99152","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":420.29,"maximum":647.89,"gross_charge":793,"discounted_cash":181.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.89,"methodology":"fee schedule"}]}]},{"description":"MOD SEDAT =>5YRS 1ST 15M","code_information":[{"code":"99152","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":12.52,"maximum":647.89,"gross_charge":793,"discounted_cash":181.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":44.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":44.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"}]}]},{"description":"MODERATE SEDAT ADD 15MIN","code_information":[{"code":"99153","type":"CPT"},{"code":"0371","type":"RC"}],"standard_charges":[{"minimum":228.43,"maximum":352.13,"gross_charge":431,"discounted_cash":98.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":228.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.13,"methodology":"fee schedule"}]}]},{"description":"MODERATE SEDAT ADD 15MIN","code_information":[{"code":"99153","type":"CPT"},{"code":"0371","type":"RC"}],"standard_charges":[{"minimum":12.16,"maximum":352.13,"gross_charge":431,"discounted_cash":98.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":228.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"}]}]},{"description":"MOD SED <5Y 1ST 15 OTH MD","code_information":[{"code":"99155","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":420.29,"maximum":647.89,"gross_charge":793,"discounted_cash":181.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.89,"methodology":"fee schedule"}]}]},{"description":"MOD SED <5Y 1ST 15 OTH MD","code_information":[{"code":"99155","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":86.19,"maximum":647.89,"gross_charge":793,"discounted_cash":181.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":447.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":335.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":335.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.19,"methodology":"fee schedule"}]}]},{"description":"MOD SED =>5Y 1ST 15 OTH MD","code_information":[{"code":"99156","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":420.29,"maximum":647.89,"gross_charge":793,"discounted_cash":181.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.89,"methodology":"fee schedule"}]}]},{"description":"MOD SED =>5Y 1ST 15 OTH MD","code_information":[{"code":"99156","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":78.32,"maximum":647.89,"gross_charge":793,"discounted_cash":181.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":365.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":273.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":273.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.32,"methodology":"fee schedule"}]}]},{"description":"MOD SEDAT ADD 15M OTH MD","code_information":[{"code":"99157","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":228.43,"maximum":352.13,"gross_charge":431,"discounted_cash":98.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":228.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.13,"methodology":"fee schedule"}]}]},{"description":"MOD SEDAT ADD 15M OTH MD","code_information":[{"code":"99157","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":61.87,"maximum":352.13,"gross_charge":431,"discounted_cash":98.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":207.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":207.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":228.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.87,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 1","code_information":[{"code":"99281","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":324.89,"maximum":500.83,"gross_charge":613,"discounted_cash":140.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":324.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.83,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 1","code_information":[{"code":"99281","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":9.85,"maximum":769,"gross_charge":613,"discounted_cash":140.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":288,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":769,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":769,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":324.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":94.79,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":96.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":93.85,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 2","code_information":[{"code":"99282","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":615.86,"maximum":949.36,"gross_charge":1162,"discounted_cash":266.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":615.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":949.36,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 2","code_information":[{"code":"99282","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":36.41,"maximum":949.36,"gross_charge":1162,"discounted_cash":266.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":669,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":669,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":769,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":769,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":615.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":949.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":168.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":170.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":173.85,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":172.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":168.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":168.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":168.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":173,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":168.78,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 3","code_information":[{"code":"99283","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1077.49,"maximum":1660.97,"gross_charge":2033,"discounted_cash":465.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1077.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1660.97,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 3","code_information":[{"code":"99283","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":62.07,"maximum":1831,"gross_charge":2033,"discounted_cash":465.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1831,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1831,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1536,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1536,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1077.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1660.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":295.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":298.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":303.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":301.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":295.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":295.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":295.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":302.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":295.11,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 4","code_information":[{"code":"99284","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1710.31,"maximum":2636.46,"gross_charge":3227,"discounted_cash":738.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1710.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2636.46,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 4","code_information":[{"code":"99284","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":105.34,"maximum":2927,"gross_charge":3227,"discounted_cash":738.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2927,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2927,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1536,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1536,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1710.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2636.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":458.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":467.47,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":462.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":465.2,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":453.85,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 5","code_information":[{"code":"99285","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2188.9,"maximum":3374.21,"gross_charge":4130,"discounted_cash":945.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2188.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3374.21,"methodology":"fee schedule"}]}]},{"description":"ER LEVEL 5","code_information":[{"code":"99285","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":152.79,"maximum":3374.21,"gross_charge":4130,"discounted_cash":945.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3142,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3142,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1536,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1536,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2188.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3374.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":659.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":673.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":666.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":669.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"}]}]},{"description":"ER CRITICAL CARE 30-74MINS","code_information":[{"code":"99291","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":6396.04,"maximum":9859.56,"gross_charge":12068,"discounted_cash":2763.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6396.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9859.56,"methodology":"fee schedule"}]}]},{"description":"ER CRITICAL CARE 30-74MINS","code_information":[{"code":"99291","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":185.32,"maximum":9859.56,"gross_charge":12068,"discounted_cash":2763.58,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3113,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3113,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6396.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9859.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.32,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":898.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":907.06,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":925.02,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":916.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":898.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":898.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":898.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":920.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":898.07,"methodology":"fee schedule"}]}]},{"description":"ER CRITICAL CARE EA ADD 30MIN","code_information":[{"code":"99292","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3454.01,"maximum":5324.39,"gross_charge":6517,"discounted_cash":1492.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3454.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5324.39,"methodology":"fee schedule"}]}]},{"description":"ER CRITICAL CARE EA ADD 30MIN","code_information":[{"code":"99292","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":93.41,"maximum":5324.39,"gross_charge":6517,"discounted_cash":1492.4,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3113,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3113,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3454.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5324.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.41,"methodology":"fee schedule"}]}]},{"description":"SMOKING/TOBACCO COUNSEL >10MIN","code_information":[{"code":"99407","type":"CPT"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":98.05,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"}]}]},{"description":"SMOKING/TOBACCO COUNSEL >10MIN","code_information":[{"code":"99407","type":"CPT"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":25.9,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":87.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":87.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"}]}]},{"description":"PATIENT CONVENIENCE ITEMS OTHER","code_information":[{"code":"999","type":"RC"}],"standard_charges":[{"minimum":14.83,"maximum":19.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NACL 0.9% 3ML NEB","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"A4218","type":"HCPCS"},{"code":"0272","type":"RC"},{"code":"00487-9301-33","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":1.64,"gross_charge":2,"discounted_cash":0.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 3ML NEB","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"A4218","type":"HCPCS"},{"code":"0272","type":"RC"},{"code":"00487-9301-33","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":6.64,"gross_charge":2,"discounted_cash":0.46,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"}]}]},{"description":"ACETAMIN 325MG SUPP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00713-0164-12","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":1.64,"gross_charge":2,"discounted_cash":0.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"}]}]},{"description":"ACETAMIN 325MG SUPP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00713-0164-12","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":142.34,"gross_charge":2,"discounted_cash":0.46,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00527-1050-01","type":"NDC"}],"standard_charges":[{"minimum":15.37,"maximum":23.7,"gross_charge":29,"discounted_cash":6.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00527-1050-01","type":"NDC"}],"standard_charges":[{"minimum":4.06,"maximum":142.34,"gross_charge":29,"discounted_cash":6.65,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"}]}]},{"description":"ACETIC ACID/HC 10ML OTIC SOL","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51672-3007-01","type":"NDC"}],"standard_charges":[{"minimum":1017.6,"maximum":1568.64,"gross_charge":1920,"discounted_cash":439.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1017.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1568.64,"methodology":"fee schedule"}]}]},{"description":"ACETIC ACID/HC 10ML OTIC SOL","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51672-3007-01","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":1568.64,"gross_charge":1920,"discounted_cash":439.68,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1017.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1568.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.8,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR 200MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68084-0107-01","type":"NDC"}],"standard_charges":[{"minimum":6.36,"maximum":9.81,"gross_charge":12,"discounted_cash":2.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR 200MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68084-0107-01","type":"NDC"}],"standard_charges":[{"minimum":1.68,"maximum":142.34,"gross_charge":12,"discounted_cash":2.75,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL HFA 90MCG 8GM INH","drug_information": {"unit": 8,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00173-0682-24","type":"NDC"}],"standard_charges":[{"minimum":78.44,"maximum":120.92,"gross_charge":148,"discounted_cash":33.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL HFA 90MCG 8GM INH","drug_information": {"unit": 8,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00173-0682-24","type":"NDC"}],"standard_charges":[{"minimum":20.72,"maximum":142.34,"gross_charge":148,"discounted_cash":33.9,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL HFA 90MCG/INH 18GM","drug_information": {"unit": 18,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00173-0682-20","type":"NDC"}],"standard_charges":[{"minimum":244.86,"maximum":377.46,"gross_charge":462,"discounted_cash":105.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.46,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL HFA 90MCG/INH 18GM","drug_information": {"unit": 18,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00173-0682-20","type":"NDC"}],"standard_charges":[{"minimum":64.68,"maximum":377.46,"gross_charge":462,"discounted_cash":105.8,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":244.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.68,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL HFA 90MCG/INH 8.5GM","drug_information": {"unit": 8.5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"17270-0740-00","type":"NDC"}],"standard_charges":[{"minimum":195.04,"maximum":300.66,"gross_charge":368,"discounted_cash":84.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":195.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":300.66,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL HFA 90MCG/INH 8.5GM","drug_information": {"unit": 8.5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"17270-0740-00","type":"NDC"}],"standard_charges":[{"minimum":51.52,"maximum":300.66,"gross_charge":368,"discounted_cash":84.28,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":195.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":300.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51079-0205-20","type":"NDC"}],"standard_charges":[{"minimum":2.12,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51079-0205-20","type":"NDC"}],"standard_charges":[{"minimum":0.56,"maximum":142.34,"gross_charge":4,"discounted_cash":0.92,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-7410-61","type":"NDC"}],"standard_charges":[{"minimum":2.65,"maximum":4.09,"gross_charge":5,"discounted_cash":1.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-7410-61","type":"NDC"}],"standard_charges":[{"minimum":0.7,"maximum":142.34,"gross_charge":5,"discounted_cash":1.15,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"}]}]},{"description":"AMOX/CLAV 250-62.5MG/5 5ML LIQ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"60432-0065-00","type":"NDC"}],"standard_charges":[{"minimum":389.55,"maximum":600.5,"gross_charge":735,"discounted_cash":168.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":389.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.5,"methodology":"fee schedule"}]}]},{"description":"AMOX/CLAV 250-62.5MG/5 5ML LIQ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"60432-0065-00","type":"NDC"}],"standard_charges":[{"minimum":102.9,"maximum":600.5,"gross_charge":735,"discounted_cash":168.32,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":389.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.9,"methodology":"fee schedule"}]}]},{"description":"AMOX/CLAV 500/125MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42571-0161-42","type":"NDC"}],"standard_charges":[{"minimum":17.49,"maximum":26.97,"gross_charge":33,"discounted_cash":7.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"}]}]},{"description":"AMOX/CLAV 500/125MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42571-0161-42","type":"NDC"}],"standard_charges":[{"minimum":4.62,"maximum":142.34,"gross_charge":33,"discounted_cash":7.56,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"}]}]},{"description":"AMYL/LIPASE/PRO ER 27/5/17 CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00023-6115-01","type":"NDC"}],"standard_charges":[{"minimum":8.48,"maximum":13.08,"gross_charge":16,"discounted_cash":3.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"}]}]},{"description":"AMYL/LIPASE/PRO ER 27/5/17 CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00023-6115-01","type":"NDC"}],"standard_charges":[{"minimum":2.24,"maximum":142.34,"gross_charge":16,"discounted_cash":3.67,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"62332-0099-30","type":"NDC"}],"standard_charges":[{"minimum":144.16,"maximum":222.23,"gross_charge":272,"discounted_cash":62.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"62332-0099-30","type":"NDC"}],"standard_charges":[{"minimum":38.08,"maximum":222.23,"gross_charge":272,"discounted_cash":62.29,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"67877-0431-05","type":"NDC"}],"standard_charges":[{"minimum":144.69,"maximum":223.05,"gross_charge":273,"discounted_cash":62.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.05,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"67877-0431-05","type":"NDC"}],"standard_charges":[{"minimum":38.22,"maximum":223.05,"gross_charge":273,"discounted_cash":62.52,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 300MG SUPP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00574-7034-12","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":2.46,"gross_charge":3,"discounted_cash":0.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 300MG SUPP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00574-7034-12","type":"NDC"}],"standard_charges":[{"minimum":0.42,"maximum":142.34,"gross_charge":3,"discounted_cash":0.69,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00071-0155-23","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00071-0155-23","type":"NDC"}],"standard_charges":[{"minimum":7.56,"maximum":142.34,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"}]}]},{"description":"AZELASTINE 0.1% 137MCG30MLSPRY","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"59651-0214-30","type":"NDC"}],"standard_charges":[{"minimum":474.35,"maximum":731.22,"gross_charge":895,"discounted_cash":204.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":474.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":731.22,"methodology":"fee schedule"}]}]},{"description":"AZELASTINE 0.1% 137MCG30MLSPRY","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"59651-0214-30","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":731.22,"gross_charge":895,"discounted_cash":204.96,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":474.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":731.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.3,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 200/5 5ML PEDPO","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00069-3120-19","type":"NDC"}],"standard_charges":[{"minimum":343.97,"maximum":530.24,"gross_charge":649,"discounted_cash":148.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":343.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":530.24,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 200/5 5ML PEDPO","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00069-3120-19","type":"NDC"}],"standard_charges":[{"minimum":90.86,"maximum":530.24,"gross_charge":649,"discounted_cash":148.63,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":343.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":530.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.86,"methodology":"fee schedule"}]}]},{"description":"BACLOFEN 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00172-4096-60","type":"NDC"}],"standard_charges":[{"minimum":11.66,"maximum":17.98,"gross_charge":22,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"BACLOFEN 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00172-4096-60","type":"NDC"}],"standard_charges":[{"minimum":3.08,"maximum":142.34,"gross_charge":22,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"}]}]},{"description":"BENZOCAINE/TETRACAINE 20GM SPY","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"10223-0201-03","type":"NDC"}],"standard_charges":[{"minimum":326.48,"maximum":503.28,"gross_charge":616,"discounted_cash":141.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":326.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":503.28,"methodology":"fee schedule"}]}]},{"description":"BENZOCAINE/TETRACAINE 20GM SPY","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"10223-0201-03","type":"NDC"}],"standard_charges":[{"minimum":86.24,"maximum":503.28,"gross_charge":616,"discounted_cash":141.07,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":326.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":503.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.24,"methodology":"fee schedule"}]}]},{"description":"BIC/EMTR/TENO 50/200/25MGTAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61958-2501-01","type":"NDC"}],"standard_charges":[{"minimum":531.06,"maximum":818.64,"gross_charge":1002,"discounted_cash":229.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":818.64,"methodology":"fee schedule"}]}]},{"description":"BIC/EMTR/TENO 50/200/25MGTAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61958-2501-01","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":818.64,"gross_charge":1002,"discounted_cash":229.46,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":531.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":818.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.28,"methodology":"fee schedule"}]}]},{"description":"BRIMONIDINE 0.2% 10ML OPH SOL","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"70069-0232-01","type":"NDC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"BRIMONIDINE 0.2% 10ML OPH SOL","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"70069-0232-01","type":"NDC"}],"standard_charges":[{"minimum":10.08,"maximum":142.34,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"}]}]},{"description":"BRIMONIDINE 0.2% 5ML OP SOL","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"24208-0411-05","type":"NDC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"BRIMONIDINE 0.2% 5ML OP SOL","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"24208-0411-05","type":"NDC"}],"standard_charges":[{"minimum":21.7,"maximum":142.34,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.7,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00185-0129-05","type":"NDC"}],"standard_charges":[{"minimum":4.24,"maximum":6.54,"gross_charge":8,"discounted_cash":1.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00185-0129-05","type":"NDC"}],"standard_charges":[{"minimum":1.12,"maximum":142.34,"gross_charge":8,"discounted_cash":1.84,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"}]}]},{"description":"BUSPIRONE 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68382-0180-05","type":"NDC"}],"standard_charges":[{"minimum":3.71,"maximum":5.72,"gross_charge":7,"discounted_cash":1.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"}]}]},{"description":"BUSPIRONE 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68382-0180-05","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":142.34,"gross_charge":7,"discounted_cash":1.61,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"}]}]},{"description":"CANAGLIFLOZIN 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50458-0140-90","type":"NDC"}],"standard_charges":[{"minimum":89.57,"maximum":138.08,"gross_charge":169,"discounted_cash":38.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.08,"methodology":"fee schedule"}]}]},{"description":"CANAGLIFLOZIN 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50458-0140-90","type":"NDC"}],"standard_charges":[{"minimum":23.66,"maximum":142.34,"gross_charge":169,"discounted_cash":38.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.66,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00078-0509-05","type":"NDC"}],"standard_charges":[{"minimum":7.42,"maximum":11.44,"gross_charge":14,"discounted_cash":3.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00078-0509-05","type":"NDC"}],"standard_charges":[{"minimum":1.96,"maximum":142.34,"gross_charge":14,"discounted_cash":3.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 250MG/5ML 60ML SUSP","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-4137-64","type":"NDC"}],"standard_charges":[{"minimum":446.79,"maximum":688.74,"gross_charge":843,"discounted_cash":193.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":446.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":688.74,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 250MG/5ML 60ML SUSP","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-4137-64","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":688.74,"gross_charge":843,"discounted_cash":193.05,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":446.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":688.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.02,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-3160-06","type":"NDC"}],"standard_charges":[{"minimum":23.32,"maximum":35.95,"gross_charge":44,"discounted_cash":10.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-3160-06","type":"NDC"}],"standard_charges":[{"minimum":6.16,"maximum":142.34,"gross_charge":44,"discounted_cash":10.08,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"}]}]},{"description":"CEPHALEXIN 250/5 100ML SUSP","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-4177-73","type":"NDC"}],"standard_charges":[{"minimum":113.42,"maximum":174.84,"gross_charge":214,"discounted_cash":49.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":113.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.84,"methodology":"fee schedule"}]}]},{"description":"CEPHALEXIN 250/5 100ML SUSP","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-4177-73","type":"NDC"}],"standard_charges":[{"minimum":29.96,"maximum":174.84,"gross_charge":214,"discounted_cash":49.01,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":113.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.96,"methodology":"fee schedule"}]}]},{"description":"CEPHALEXIN 250/5 200ML SUSP","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-4177-74","type":"NDC"}],"standard_charges":[{"minimum":201.4,"maximum":310.46,"gross_charge":380,"discounted_cash":87.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":201.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":310.46,"methodology":"fee schedule"}]}]},{"description":"CEPHALEXIN 250/5 200ML SUSP","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-4177-74","type":"NDC"}],"standard_charges":[{"minimum":53.2,"maximum":310.46,"gross_charge":380,"discounted_cash":87.02,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":201.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":310.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.2,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 0.3% 2.5ML OPS","drug_information": {"unit": 2.5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16571-0120-25","type":"NDC"}],"standard_charges":[{"minimum":117.13,"maximum":180.56,"gross_charge":221,"discounted_cash":50.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":180.56,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 0.3% 2.5ML OPS","drug_information": {"unit": 2.5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16571-0120-25","type":"NDC"}],"standard_charges":[{"minimum":30.94,"maximum":180.56,"gross_charge":221,"discounted_cash":50.61,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":180.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.94,"methodology":"fee schedule"}]}]},{"description":"CITRIC ACID/NA CIT 15ML SOL","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00121-0595-00","type":"NDC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"CITRIC ACID/NA CIT 15ML SOL","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00121-0595-00","type":"NDC"}],"standard_charges":[{"minimum":7,"maximum":142.34,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42571-0251-01","type":"NDC"}],"standard_charges":[{"minimum":5.83,"maximum":8.99,"gross_charge":11,"discounted_cash":2.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42571-0251-01","type":"NDC"}],"standard_charges":[{"minimum":1.54,"maximum":142.34,"gross_charge":11,"discounted_cash":2.52,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05% 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"21922-0016-04","type":"NDC"}],"standard_charges":[{"minimum":577.7,"maximum":890.53,"gross_charge":1090,"discounted_cash":249.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":577.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":890.53,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05% 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"21922-0016-04","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":890.53,"gross_charge":1090,"discounted_cash":249.61,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":577.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":890.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.6,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05% 15GM OINT","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51672-1259-01","type":"NDC"}],"standard_charges":[{"minimum":700.66,"maximum":1080.08,"gross_charge":1322,"discounted_cash":302.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":700.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1080.08,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05% 15GM OINT","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51672-1259-01","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":1080.08,"gross_charge":1322,"discounted_cash":302.74,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":700.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1080.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.08,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1MG/24HR PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-0871-99","type":"NDC"}],"standard_charges":[{"minimum":149.46,"maximum":230.4,"gross_charge":282,"discounted_cash":64.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1MG/24HR PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-0871-99","type":"NDC"}],"standard_charges":[{"minimum":39.48,"maximum":230.4,"gross_charge":282,"discounted_cash":64.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.48,"methodology":"fee schedule"}]}]},{"description":"CLOPIDOGREL 75MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65862-0357-05","type":"NDC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"CLOPIDOGREL 75MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65862-0357-05","type":"NDC"}],"standard_charges":[{"minimum":8.4,"maximum":142.34,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1% 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-7822-36","type":"NDC"}],"standard_charges":[{"minimum":23.85,"maximum":36.77,"gross_charge":45,"discounted_cash":10.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1% 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-7822-36","type":"NDC"}],"standard_charges":[{"minimum":6.3,"maximum":142.34,"gross_charge":45,"discounted_cash":10.31,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"}]}]},{"description":"COLCHICINE 0.6MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"31722-0899-30","type":"NDC"}],"standard_charges":[{"minimum":30.74,"maximum":47.39,"gross_charge":58,"discounted_cash":13.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"}]}]},{"description":"COLCHICINE 0.6MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"31722-0899-30","type":"NDC"}],"standard_charges":[{"minimum":8.12,"maximum":142.34,"gross_charge":58,"discounted_cash":13.29,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"}]}]},{"description":"COLLAGENASE 250U/GM 30GM OINT","drug_information": {"unit": 30,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50484-0010-30","type":"NDC"}],"standard_charges":[{"minimum":1169.18,"maximum":1802.31,"gross_charge":2206,"discounted_cash":505.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1169.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1802.31,"methodology":"fee schedule"}]}]},{"description":"COLLAGENASE 250U/GM 30GM OINT","drug_information": {"unit": 30,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50484-0010-30","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":1802.31,"gross_charge":2206,"discounted_cash":505.18,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1169.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1802.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.84,"methodology":"fee schedule"}]}]},{"description":"DEXAMETH/NEO/POLY 3.5GM OPO","drug_information": {"unit": 3.5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61314-0631-36","type":"NDC"}],"standard_charges":[{"minimum":198.75,"maximum":306.38,"gross_charge":375,"discounted_cash":85.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":198.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306.38,"methodology":"fee schedule"}]}]},{"description":"DEXAMETH/NEO/POLY 3.5GM OPO","drug_information": {"unit": 3.5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61314-0631-36","type":"NDC"}],"standard_charges":[{"minimum":52.5,"maximum":306.38,"gross_charge":375,"discounted_cash":85.88,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":198.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.5,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 0.125MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57664-0437-88","type":"NDC"}],"standard_charges":[{"minimum":6.89,"maximum":10.63,"gross_charge":13,"discounted_cash":2.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 0.125MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57664-0437-88","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":142.34,"gross_charge":13,"discounted_cash":2.98,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX DR 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57237-0047-01","type":"NDC"}],"standard_charges":[{"minimum":7.95,"maximum":12.26,"gross_charge":15,"discounted_cash":3.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX DR 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57237-0047-01","type":"NDC"}],"standard_charges":[{"minimum":2.1,"maximum":142.34,"gross_charge":15,"discounted_cash":3.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"}]}]},{"description":"DORZOLAMIDE 2% 10ML OP SOL","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72266-0197-01","type":"NDC"}],"standard_charges":[{"minimum":81.09,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"}]}]},{"description":"DORZOLAMIDE 2% 10ML OP SOL","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72266-0197-01","type":"NDC"}],"standard_charges":[{"minimum":21.42,"maximum":142.34,"gross_charge":153,"discounted_cash":35.04,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE 100MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-0428-06","type":"NDC"}],"standard_charges":[{"minimum":9.54,"maximum":14.71,"gross_charge":18,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE 100MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-0428-06","type":"NDC"}],"standard_charges":[{"minimum":2.52,"maximum":142.34,"gross_charge":18,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE DR 20MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-3235-60","type":"NDC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE DR 20MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-3235-60","type":"NDC"}],"standard_charges":[{"minimum":7.84,"maximum":142.34,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE DR 30MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57237-0018-90","type":"NDC"}],"standard_charges":[{"minimum":35.51,"maximum":54.74,"gross_charge":67,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE DR 30MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57237-0018-90","type":"NDC"}],"standard_charges":[{"minimum":9.38,"maximum":142.34,"gross_charge":67,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"}]}]},{"description":"EMPAGLIFLOZIN 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00597-0152-37","type":"NDC"}],"standard_charges":[{"minimum":94.34,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"}]}]},{"description":"EMPAGLIFLOZIN 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00597-0152-37","type":"NDC"}],"standard_charges":[{"minimum":24.92,"maximum":145.43,"gross_charge":178,"discounted_cash":40.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.92,"methodology":"fee schedule"}]}]},{"description":"EMPAGLIFLOZIN 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00597-0153-90","type":"NDC"}],"standard_charges":[{"minimum":99.11,"maximum":152.78,"gross_charge":187,"discounted_cash":42.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":99.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":152.78,"methodology":"fee schedule"}]}]},{"description":"EMPAGLIFLOZIN 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00597-0153-90","type":"NDC"}],"standard_charges":[{"minimum":26.18,"maximum":152.78,"gross_charge":187,"discounted_cash":42.83,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":99.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":152.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.18,"methodology":"fee schedule"}]}]},{"description":"EMTRICITAB-TENOFOV 200/300MGTB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61958-0701-01","type":"NDC"}],"standard_charges":[{"minimum":199.28,"maximum":307.2,"gross_charge":376,"discounted_cash":86.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":199.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":307.2,"methodology":"fee schedule"}]}]},{"description":"EMTRICITAB-TENOFOV 200/300MGTB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61958-0701-01","type":"NDC"}],"standard_charges":[{"minimum":52.64,"maximum":307.2,"gross_charge":376,"discounted_cash":86.11,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":199.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":307.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1% 30ML TOP SOL","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42023-0103-01","type":"NDC"}],"standard_charges":[{"minimum":68.37,"maximum":105.4,"gross_charge":129,"discounted_cash":29.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1% 30ML TOP SOL","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42023-0103-01","type":"NDC"}],"standard_charges":[{"minimum":18.06,"maximum":142.34,"gross_charge":129,"discounted_cash":29.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.06,"methodology":"fee schedule"}]}]},{"description":"ERYTHRO 0.5% 1GM OPTH OINT","drug_information": {"unit": 1,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72485-0670-31","type":"NDC"}],"standard_charges":[{"minimum":90.63,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"}]}]},{"description":"ERYTHRO 0.5% 1GM OPTH OINT","drug_information": {"unit": 1,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72485-0670-31","type":"NDC"}],"standard_charges":[{"minimum":23.94,"maximum":142.34,"gross_charge":171,"discounted_cash":39.16,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"}]}]},{"description":"ERYTHRO BASE 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"24338-0102-13","type":"NDC"}],"standard_charges":[{"minimum":27.03,"maximum":41.67,"gross_charge":51,"discounted_cash":11.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"}]}]},{"description":"ERYTHRO BASE 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"24338-0102-13","type":"NDC"}],"standard_charges":[{"minimum":7.14,"maximum":142.34,"gross_charge":51,"discounted_cash":11.68,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 42.5GM VAG CRM","drug_information": {"unit": 42.5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00430-3754-14","type":"NDC"}],"standard_charges":[{"minimum":1864.01,"maximum":2873.39,"gross_charge":3517,"discounted_cash":805.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1864.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2873.39,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 42.5GM VAG CRM","drug_information": {"unit": 42.5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00430-3754-14","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":2873.39,"gross_charge":3517,"discounted_cash":805.4,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1864.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2873.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.38,"methodology":"fee schedule"}]}]},{"description":"ESTROGENS CONJ 30GM VAG CRM","drug_information": {"unit": 30,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00046-0872-21","type":"NDC"}],"standard_charges":[{"minimum":1154.87,"maximum":1780.25,"gross_charge":2179,"discounted_cash":499,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1154.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1780.25,"methodology":"fee schedule"}]}]},{"description":"ESTROGENS CONJ 30GM VAG CRM","drug_information": {"unit": 30,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00046-0872-21","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":1780.25,"gross_charge":2179,"discounted_cash":499,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1154.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1780.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.06,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE NANO 145MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68084-0636-95","type":"NDC"}],"standard_charges":[{"minimum":20.67,"maximum":31.87,"gross_charge":39,"discounted_cash":8.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE NANO 145MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68084-0636-95","type":"NDC"}],"standard_charges":[{"minimum":5.46,"maximum":142.34,"gross_charge":39,"discounted_cash":8.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100MCG/HR PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"47781-0428-47","type":"NDC"}],"standard_charges":[{"minimum":355.1,"maximum":547.39,"gross_charge":670,"discounted_cash":153.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":355.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":547.39,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100MCG/HR PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"47781-0428-47","type":"NDC"}],"standard_charges":[{"minimum":93.8,"maximum":547.39,"gross_charge":670,"discounted_cash":153.43,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":355.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":547.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.8,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12MCG PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-9119-98","type":"NDC"}],"standard_charges":[{"minimum":91.69,"maximum":141.35,"gross_charge":173,"discounted_cash":39.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.35,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12MCG PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-9119-98","type":"NDC"}],"standard_charges":[{"minimum":24.22,"maximum":142.34,"gross_charge":173,"discounted_cash":39.62,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.22,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25MCG PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-9121-98","type":"NDC"}],"standard_charges":[{"minimum":65.19,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25MCG PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-9121-98","type":"NDC"}],"standard_charges":[{"minimum":17.22,"maximum":142.34,"gross_charge":123,"discounted_cash":28.17,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50MCG/HR PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00406-9150-76","type":"NDC"}],"standard_charges":[{"minimum":119.25,"maximum":183.83,"gross_charge":225,"discounted_cash":51.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":119.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.83,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50MCG/HR PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00406-9150-76","type":"NDC"}],"standard_charges":[{"minimum":31.5,"maximum":183.83,"gross_charge":225,"discounted_cash":51.53,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":119.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.5,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75MCG/HR PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-9123-98","type":"NDC"}],"standard_charges":[{"minimum":180.73,"maximum":278.6,"gross_charge":341,"discounted_cash":78.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":180.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":278.6,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75MCG/HR PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-9123-98","type":"NDC"}],"standard_charges":[{"minimum":47.74,"maximum":278.6,"gross_charge":341,"discounted_cash":78.09,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":180.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":278.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.74,"methodology":"fee schedule"}]}]},{"description":"FIDAXOMICIN 200MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"52015-0080-01","type":"NDC"}],"standard_charges":[{"minimum":799.77,"maximum":1232.86,"gross_charge":1509,"discounted_cash":345.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":799.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1232.86,"methodology":"fee schedule"}]}]},{"description":"FIDAXOMICIN 200MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"52015-0080-01","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":1232.86,"gross_charge":1509,"discounted_cash":345.57,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":799.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1232.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.26,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00054-0011-25","type":"NDC"}],"standard_charges":[{"minimum":12.72,"maximum":19.61,"gross_charge":24,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00054-0011-25","type":"NDC"}],"standard_charges":[{"minimum":3.36,"maximum":142.34,"gross_charge":24,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00049-3420-30","type":"NDC"}],"standard_charges":[{"minimum":98.05,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00049-3420-30","type":"NDC"}],"standard_charges":[{"minimum":25.9,"maximum":151.15,"gross_charge":185,"discounted_cash":42.37,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 150MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00049-3500-79","type":"NDC"}],"standard_charges":[{"minimum":155.29,"maximum":239.39,"gross_charge":293,"discounted_cash":67.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":155.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":239.39,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 150MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00049-3500-79","type":"NDC"}],"standard_charges":[{"minimum":41.02,"maximum":239.39,"gross_charge":293,"discounted_cash":67.1,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":155.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":239.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"}]}]},{"description":"FLUTICASONE 50MCG/SPY 16GM NAS","drug_information": {"unit": 16,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00054-3270-99","type":"NDC"}],"standard_charges":[{"minimum":420.82,"maximum":648.7,"gross_charge":794,"discounted_cash":181.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":648.7,"methodology":"fee schedule"}]}]},{"description":"FLUTICASONE 50MCG/SPY 16GM NAS","drug_information": {"unit": 16,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00054-3270-99","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":648.7,"gross_charge":794,"discounted_cash":181.83,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":420.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":648.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.16,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN GRAN 3GM PKT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"69097-0579-67","type":"NDC"}],"standard_charges":[{"minimum":452.62,"maximum":697.72,"gross_charge":854,"discounted_cash":195.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":452.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":697.72,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN GRAN 3GM PKT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"69097-0579-67","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":697.72,"gross_charge":854,"discounted_cash":195.57,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":452.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":697.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.56,"methodology":"fee schedule"}]}]},{"description":"GATIFLOXACIN 0.5% 2.5ML OPS","drug_information": {"unit": 2.5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68180-0435-01","type":"NDC"}],"standard_charges":[{"minimum":532.65,"maximum":821.09,"gross_charge":1005,"discounted_cash":230.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":532.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":821.09,"methodology":"fee schedule"}]}]},{"description":"GATIFLOXACIN 0.5% 2.5ML OPS","drug_information": {"unit": 2.5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68180-0435-01","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":821.09,"gross_charge":1005,"discounted_cash":230.15,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":532.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":821.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.7,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.3% 3.5GM OP OINT","drug_information": {"unit": 3.5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"17478-0284-35","type":"NDC"}],"standard_charges":[{"minimum":89.04,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.3% 3.5GM OP OINT","drug_information": {"unit": 3.5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"17478-0284-35","type":"NDC"}],"standard_charges":[{"minimum":23.52,"maximum":142.34,"gross_charge":168,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 15GM OINT","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0046-35","type":"NDC"}],"standard_charges":[{"minimum":140.98,"maximum":217.33,"gross_charge":266,"discounted_cash":60.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.33,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 15GM OINT","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0046-35","type":"NDC"}],"standard_charges":[{"minimum":37.24,"maximum":217.33,"gross_charge":266,"discounted_cash":60.92,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":140.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.24,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00832-1540-01","type":"NDC"}],"standard_charges":[{"minimum":5.3,"maximum":8.17,"gross_charge":10,"discounted_cash":2.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00832-1540-01","type":"NDC"}],"standard_charges":[{"minimum":1.4,"maximum":142.34,"gross_charge":10,"discounted_cash":2.29,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"HYDROCORT 2.5% 20GM CRM","drug_information": {"unit": 20,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00472-0337-20","type":"NDC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"HYDROCORT 2.5% 20GM CRM","drug_information": {"unit": 20,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00472-0337-20","type":"NDC"}],"standard_charges":[{"minimum":9.94,"maximum":142.34,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"}]}]},{"description":"HYDROXYCHLOROQUINE 200MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"69238-1544-01","type":"NDC"}],"standard_charges":[{"minimum":20.14,"maximum":31.05,"gross_charge":38,"discounted_cash":8.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"}]}]},{"description":"HYDROXYCHLOROQUINE 200MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"69238-1544-01","type":"NDC"}],"standard_charges":[{"minimum":5.32,"maximum":142.34,"gross_charge":38,"discounted_cash":8.71,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"}]}]},{"description":"HYDROXYUREA 500MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00003-0830-50","type":"NDC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"HYDROXYUREA 500MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00003-0830-50","type":"NDC"}],"standard_charges":[{"minimum":8.82,"maximum":142.34,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 100MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50458-0290-04","type":"NDC"}],"standard_charges":[{"minimum":152.64,"maximum":235.3,"gross_charge":288,"discounted_cash":65.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":152.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 100MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50458-0290-04","type":"NDC"}],"standard_charges":[{"minimum":40.32,"maximum":235.3,"gross_charge":288,"discounted_cash":65.96,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":152.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"}]}]},{"description":"KCL 10% 20MEQ/15ML 15ML LIQ","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"66689-0047-50","type":"NDC"}],"standard_charges":[{"minimum":70.49,"maximum":108.67,"gross_charge":133,"discounted_cash":30.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"}]}]},{"description":"KCL 10% 20MEQ/15ML 15ML LIQ","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"66689-0047-50","type":"NDC"}],"standard_charges":[{"minimum":18.62,"maximum":142.34,"gross_charge":133,"discounted_cash":30.46,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":70.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00131-2478-35","type":"NDC"}],"standard_charges":[{"minimum":52.47,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00131-2478-35","type":"NDC"}],"standard_charges":[{"minimum":13.86,"maximum":142.34,"gross_charge":99,"discounted_cash":22.68,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"}]}]},{"description":"LACTULOSE 10GM/15ML 473ML SYRP","drug_information": {"unit": 480,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"64980-0592-48","type":"NDC"}],"standard_charges":[{"minimum":159,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"}]}]},{"description":"LACTULOSE 10GM/15ML 473ML SYRP","drug_information": {"unit": 480,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"64980-0592-48","type":"NDC"}],"standard_charges":[{"minimum":42,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"}]}]},{"description":"LAMOTRIGINE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"62332-0038-31","type":"NDC"}],"standard_charges":[{"minimum":21.73,"maximum":33.5,"gross_charge":41,"discounted_cash":9.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"}]}]},{"description":"LAMOTRIGINE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"62332-0038-31","type":"NDC"}],"standard_charges":[{"minimum":5.74,"maximum":142.34,"gross_charge":41,"discounted_cash":9.39,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"}]}]},{"description":"LAMOTRIGINE 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16714-0194-01","type":"NDC"}],"standard_charges":[{"minimum":19.61,"maximum":30.23,"gross_charge":37,"discounted_cash":8.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"}]}]},{"description":"LAMOTRIGINE 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16714-0194-01","type":"NDC"}],"standard_charges":[{"minimum":5.18,"maximum":142.34,"gross_charge":37,"discounted_cash":8.48,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"LATANOPROST 0.005% 2.5ML OPSOL","drug_information": {"unit": 2.5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00013-8303-04","type":"NDC"}],"standard_charges":[{"minimum":613.21,"maximum":945.27,"gross_charge":1157,"discounted_cash":264.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":613.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":945.27,"methodology":"fee schedule"}]}]},{"description":"LATANOPROST 0.005% 2.5ML OPSOL","drug_information": {"unit": 2.5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00013-8303-04","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":945.27,"gross_charge":1157,"discounted_cash":264.96,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":613.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":945.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.98,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500MG/5ML LIQ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50474-0001-48","type":"NDC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500MG/5ML LIQ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50474-0001-48","type":"NDC"}],"standard_charges":[{"minimum":11.2,"maximum":142.34,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-6351-61","type":"NDC"}],"standard_charges":[{"minimum":66.78,"maximum":102.95,"gross_charge":126,"discounted_cash":28.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-6351-61","type":"NDC"}],"standard_charges":[{"minimum":17.64,"maximum":142.34,"gross_charge":126,"discounted_cash":28.86,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":66.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68180-0241-01","type":"NDC"}],"standard_charges":[{"minimum":86.92,"maximum":133.99,"gross_charge":164,"discounted_cash":37.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.99,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68180-0241-01","type":"NDC"}],"standard_charges":[{"minimum":22.96,"maximum":142.34,"gross_charge":164,"discounted_cash":37.56,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.96,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68180-0242-01","type":"NDC"}],"standard_charges":[{"minimum":163.24,"maximum":251.64,"gross_charge":308,"discounted_cash":70.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":251.64,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68180-0242-01","type":"NDC"}],"standard_charges":[{"minimum":43.12,"maximum":251.64,"gross_charge":308,"discounted_cash":70.54,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":251.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"}]}]},{"description":"LIDO/PRILOCAINE 5GM TOP","drug_information": {"unit": 5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"62332-0582-04","type":"NDC"}],"standard_charges":[{"minimum":45.05,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"}]}]},{"description":"LIDO/PRILOCAINE 5GM TOP","drug_information": {"unit": 5,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"62332-0582-04","type":"NDC"}],"standard_charges":[{"minimum":11.9,"maximum":142.34,"gross_charge":85,"discounted_cash":19.47,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 2% 11ML UROJET","drug_information": {"unit": 11,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"25021-0673-77","type":"NDC"}],"standard_charges":[{"minimum":34.45,"maximum":53.11,"gross_charge":65,"discounted_cash":14.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 2% 11ML UROJET","drug_information": {"unit": 11,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"25021-0673-77","type":"NDC"}],"standard_charges":[{"minimum":9.1,"maximum":142.34,"gross_charge":65,"discounted_cash":14.89,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 4% 4ML TOP","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"76329-6300-05","type":"NDC"}],"standard_charges":[{"minimum":38.69,"maximum":59.65,"gross_charge":73,"discounted_cash":16.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 4% 4ML TOP","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"76329-6300-05","type":"NDC"}],"standard_charges":[{"minimum":10.22,"maximum":142.34,"gross_charge":73,"discounted_cash":16.72,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 4% 50ML TOP SOL","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00054-3505-47","type":"NDC"}],"standard_charges":[{"minimum":41.34,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 4% 50ML TOP SOL","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00054-3505-47","type":"NDC"}],"standard_charges":[{"minimum":10.92,"maximum":142.34,"gross_charge":78,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72606-0001-07","type":"NDC"}],"standard_charges":[{"minimum":22.26,"maximum":34.32,"gross_charge":42,"discounted_cash":9.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72606-0001-07","type":"NDC"}],"standard_charges":[{"minimum":5.88,"maximum":142.34,"gross_charge":42,"discounted_cash":9.62,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"}]}]},{"description":"LOPERAMIDE 2MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-0311-05","type":"NDC"}],"standard_charges":[{"minimum":3.18,"maximum":4.91,"gross_charge":6,"discounted_cash":1.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"}]}]},{"description":"LOPERAMIDE 2MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00093-0311-05","type":"NDC"}],"standard_charges":[{"minimum":0.84,"maximum":142.34,"gross_charge":6,"discounted_cash":1.38,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 400MG ER CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"60687-0556-32","type":"NDC"}],"standard_charges":[{"minimum":28.09,"maximum":43.31,"gross_charge":53,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 400MG ER CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"60687-0556-32","type":"NDC"}],"standard_charges":[{"minimum":7.42,"maximum":142.34,"gross_charge":53,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"}]}]},{"description":"METHAZOLAMIDE 50MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72603-0167-01","type":"NDC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"METHAZOLAMIDE 50MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72603-0167-01","type":"NDC"}],"standard_charges":[{"minimum":9.52,"maximum":142.34,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75% 70GM VAG","drug_information": {"unit": 70,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16714-0557-01","type":"NDC"}],"standard_charges":[{"minimum":699.6,"maximum":1078.44,"gross_charge":1320,"discounted_cash":302.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":699.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1078.44,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75% 70GM VAG","drug_information": {"unit": 70,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16714-0557-01","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":1078.44,"gross_charge":1320,"discounted_cash":302.28,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":699.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1078.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.8,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"13668-0487-50","type":"NDC"}],"standard_charges":[{"minimum":27.56,"maximum":42.49,"gross_charge":52,"discounted_cash":11.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"13668-0487-50","type":"NDC"}],"standard_charges":[{"minimum":7.28,"maximum":142.34,"gross_charge":52,"discounted_cash":11.91,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"}]}]},{"description":"MIRTAZAPINE 7.5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"60687-0584-21","type":"NDC"}],"standard_charges":[{"minimum":15.9,"maximum":24.51,"gross_charge":30,"discounted_cash":6.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"MIRTAZAPINE 7.5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"60687-0584-21","type":"NDC"}],"standard_charges":[{"minimum":4.2,"maximum":142.34,"gross_charge":30,"discounted_cash":6.87,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68001-0361-04","type":"NDC"}],"standard_charges":[{"minimum":25.97,"maximum":40.04,"gross_charge":49,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68001-0361-04","type":"NDC"}],"standard_charges":[{"minimum":6.86,"maximum":142.34,"gross_charge":49,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"}]}]},{"description":"MUPIROCIN 2% 20MG/1GM UD OINT","drug_information": {"unit": 1,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00029-1526-11","type":"NDC"}],"standard_charges":[{"minimum":60.95,"maximum":93.96,"gross_charge":115,"discounted_cash":26.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"MUPIROCIN 2% 20MG/1GM UD OINT","drug_information": {"unit": 1,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00029-1526-11","type":"NDC"}],"standard_charges":[{"minimum":16.1,"maximum":142.34,"gross_charge":115,"discounted_cash":26.34,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"}]}]},{"description":"MUPIROCIN 2% 20MG/GM 22GM OINT","drug_information": {"unit": 22,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51672-1312-00","type":"NDC"}],"standard_charges":[{"minimum":112.89,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"}]}]},{"description":"MUPIROCIN 2% 20MG/GM 22GM OINT","drug_information": {"unit": 22,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51672-1312-00","type":"NDC"}],"standard_charges":[{"minimum":29.82,"maximum":174.03,"gross_charge":213,"discounted_cash":48.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.82,"methodology":"fee schedule"}]}]},{"description":"NA POLYSTYR 15GM/60ML 60ML SUS","drug_information": {"unit": 60,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"46287-0006-60","type":"NDC"}],"standard_charges":[{"minimum":50.88,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"}]}]},{"description":"NA POLYSTYR 15GM/60ML 60ML SUS","drug_information": {"unit": 60,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"46287-0006-60","type":"NDC"}],"standard_charges":[{"minimum":13.44,"maximum":142.34,"gross_charge":96,"discounted_cash":21.99,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"}]}]},{"description":"NA ZIRCONIUM CYCLOSIL 10GM PKT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00310-1110-39","type":"NDC"}],"standard_charges":[{"minimum":107.59,"maximum":165.86,"gross_charge":203,"discounted_cash":46.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.86,"methodology":"fee schedule"}]}]},{"description":"NA ZIRCONIUM CYCLOSIL 10GM PKT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00310-1110-39","type":"NDC"}],"standard_charges":[{"minimum":28.42,"maximum":165.86,"gross_charge":203,"discounted_cash":46.49,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.42,"methodology":"fee schedule"}]}]},{"description":"NITROFURAN MACR/MONO 100MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00185-0122-01","type":"NDC"}],"standard_charges":[{"minimum":14.84,"maximum":22.88,"gross_charge":28,"discounted_cash":6.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"}]}]},{"description":"NITROFURAN MACR/MONO 100MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00185-0122-01","type":"NDC"}],"standard_charges":[{"minimum":3.92,"maximum":142.34,"gross_charge":28,"discounted_cash":6.42,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"}]}]},{"description":"NITROGLYC 4.9GM 0.4MG/SPY SL","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0210-01","type":"NDC"}],"standard_charges":[{"minimum":1011.24,"maximum":1558.84,"gross_charge":1908,"discounted_cash":436.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1011.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1558.84,"methodology":"fee schedule"}]}]},{"description":"NITROGLYC 4.9GM 0.4MG/SPY SL","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0210-01","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":1558.84,"gross_charge":1908,"discounted_cash":436.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1011.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1558.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.12,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCER 0.4MG/HR 10MG PAT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-9112-93","type":"NDC"}],"standard_charges":[{"minimum":10.07,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCER 0.4MG/HR 10MG PAT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00378-9112-93","type":"NDC"}],"standard_charges":[{"minimum":2.66,"maximum":142.34,"gross_charge":19,"discounted_cash":4.36,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4MG SL TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00071-0418-13","type":"NDC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4MG SL TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00071-0418-13","type":"NDC"}],"standard_charges":[{"minimum":15.54,"maximum":142.34,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN SR 6.5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"49483-0222-10","type":"NDC"}],"standard_charges":[{"minimum":4.77,"maximum":7.36,"gross_charge":9,"discounted_cash":2.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN SR 6.5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"49483-0222-10","type":"NDC"}],"standard_charges":[{"minimum":1.26,"maximum":142.34,"gross_charge":9,"discounted_cash":2.07,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100KU/GM 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51672-1289-01","type":"NDC"}],"standard_charges":[{"minimum":79.5,"maximum":122.55,"gross_charge":150,"discounted_cash":34.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100KU/GM 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"51672-1289-01","type":"NDC"}],"standard_charges":[{"minimum":21,"maximum":142.34,"gross_charge":150,"discounted_cash":34.35,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100KU/GM 15GM PWD TOP","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00574-2008-15","type":"NDC"}],"standard_charges":[{"minimum":124.02,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100KU/GM 15GM PWD TOP","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00574-2008-15","type":"NDC"}],"standard_charges":[{"minimum":32.76,"maximum":191.18,"gross_charge":234,"discounted_cash":53.59,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":124.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.76,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3% 5ML OPS","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"11980-0779-05","type":"NDC"}],"standard_charges":[{"minimum":314.29,"maximum":484.49,"gross_charge":593,"discounted_cash":135.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":314.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":484.49,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3% 5ML OPS","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"11980-0779-05","type":"NDC"}],"standard_charges":[{"minimum":83.02,"maximum":484.49,"gross_charge":593,"discounted_cash":135.8,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":314.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":484.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.02,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE ODT 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-4453-85","type":"NDC"}],"standard_charges":[{"minimum":71.55,"maximum":110.3,"gross_charge":135,"discounted_cash":30.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE ODT 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-4453-85","type":"NDC"}],"standard_charges":[{"minimum":18.9,"maximum":142.34,"gross_charge":135,"discounted_cash":30.92,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4MG ODT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65862-0390-10","type":"NDC"}],"standard_charges":[{"minimum":100.7,"maximum":155.23,"gross_charge":190,"discounted_cash":43.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.23,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4MG ODT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65862-0390-10","type":"NDC"}],"standard_charges":[{"minimum":26.6,"maximum":155.23,"gross_charge":190,"discounted_cash":43.51,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00004-0802-85","type":"NDC"}],"standard_charges":[{"minimum":55.12,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00004-0802-85","type":"NDC"}],"standard_charges":[{"minimum":14.56,"maximum":142.34,"gross_charge":104,"discounted_cash":23.82,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 6MG/ML 12.5ML LIQ","drug_information": {"unit": 12.5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00004-0822-05","type":"NDC"}],"standard_charges":[{"minimum":171.19,"maximum":263.9,"gross_charge":323,"discounted_cash":73.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.9,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 6MG/ML 12.5ML LIQ","drug_information": {"unit": 12.5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00004-0822-05","type":"NDC"}],"standard_charges":[{"minimum":45.22,"maximum":263.9,"gross_charge":323,"discounted_cash":73.97,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.22,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 6MG/ML 60ML SUSP","drug_information": {"unit": 60,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68180-0678-01","type":"NDC"}],"standard_charges":[{"minimum":737.76,"maximum":1137.27,"gross_charge":1392,"discounted_cash":318.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":737.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1137.27,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 6MG/ML 60ML SUSP","drug_information": {"unit": 60,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"68180-0678-01","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":1137.27,"gross_charge":1392,"discounted_cash":318.77,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":737.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1137.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.88,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00004-0800-85","type":"NDC"}],"standard_charges":[{"minimum":59.89,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00004-0800-85","type":"NDC"}],"standard_charges":[{"minimum":15.82,"maximum":142.34,"gross_charge":113,"discounted_cash":25.88,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"}]}]},{"description":"OXYBUTYNIN XL 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"62175-0270-37","type":"NDC"}],"standard_charges":[{"minimum":14.31,"maximum":22.06,"gross_charge":27,"discounted_cash":6.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"}]}]},{"description":"OXYBUTYNIN XL 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"62175-0270-37","type":"NDC"}],"standard_charges":[{"minimum":3.78,"maximum":142.34,"gross_charge":27,"discounted_cash":6.19,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE EC 40MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00008-0841-81","type":"NDC"}],"standard_charges":[{"minimum":40.28,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE EC 40MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00008-0841-81","type":"NDC"}],"standard_charges":[{"minimum":10.64,"maximum":142.34,"gross_charge":76,"discounted_cash":17.41,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"}]}]},{"description":"PEG-ELECTROLYTE 4L LIQ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"52268-0100-01","type":"NDC"}],"standard_charges":[{"minimum":103.88,"maximum":160.14,"gross_charge":196,"discounted_cash":44.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"}]}]},{"description":"PEG-ELECTROLYTE 4L LIQ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"52268-0100-01","type":"NDC"}],"standard_charges":[{"minimum":27.44,"maximum":160.14,"gross_charge":196,"discounted_cash":44.89,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":103.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.44,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 5% 60GM TOP","drug_information": {"unit": 60,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0269-37","type":"NDC"}],"standard_charges":[{"minimum":557.56,"maximum":859.49,"gross_charge":1052,"discounted_cash":240.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":557.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":859.49,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 5% 60GM TOP","drug_information": {"unit": 60,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0269-37","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":859.49,"gross_charge":1052,"discounted_cash":240.91,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":557.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":859.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.28,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 4MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"23155-0800-01","type":"NDC"}],"standard_charges":[{"minimum":11.13,"maximum":17.16,"gross_charge":21,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 4MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"23155-0800-01","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":142.34,"gross_charge":21,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 8MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"52536-0168-01","type":"NDC"}],"standard_charges":[{"minimum":13.25,"maximum":20.43,"gross_charge":25,"discounted_cash":5.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 8MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"52536-0168-01","type":"NDC"}],"standard_charges":[{"minimum":3.5,"maximum":142.34,"gross_charge":25,"discounted_cash":5.73,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"}]}]},{"description":"PHENAZOPYRIDINE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65162-0681-10","type":"NDC"}],"standard_charges":[{"minimum":12.19,"maximum":18.8,"gross_charge":23,"discounted_cash":5.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"}]}]},{"description":"PHENAZOPYRIDINE 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65162-0681-10","type":"NDC"}],"standard_charges":[{"minimum":3.22,"maximum":142.34,"gross_charge":23,"discounted_cash":5.27,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 2% 15ML OP SOL","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61314-0204-15","type":"NDC"}],"standard_charges":[{"minimum":188.68,"maximum":290.86,"gross_charge":356,"discounted_cash":81.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":188.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":290.86,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 2% 15ML OP SOL","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61314-0204-15","type":"NDC"}],"standard_charges":[{"minimum":49.84,"maximum":290.86,"gross_charge":356,"discounted_cash":81.53,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":188.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":290.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"}]}]},{"description":"PIOGLITAZONE 15MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"64764-0151-04","type":"NDC"}],"standard_charges":[{"minimum":46.64,"maximum":71.9,"gross_charge":88,"discounted_cash":20.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.9,"methodology":"fee schedule"}]}]},{"description":"PIOGLITAZONE 15MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"64764-0151-04","type":"NDC"}],"standard_charges":[{"minimum":12.32,"maximum":142.34,"gross_charge":88,"discounted_cash":20.16,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 255GM PWD","drug_information": {"unit": 255,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0868-02","type":"NDC"}],"standard_charges":[{"minimum":43.99,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 255GM PWD","drug_information": {"unit": 255,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0868-02","type":"NDC"}],"standard_charges":[{"minimum":11.62,"maximum":142.34,"gross_charge":83,"discounted_cash":19.01,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"}]}]},{"description":"POSACONAZOLE DR 100 MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00085-4324-02","type":"NDC"}],"standard_charges":[{"minimum":269.24,"maximum":415.04,"gross_charge":508,"discounted_cash":116.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":269.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":415.04,"methodology":"fee schedule"}]}]},{"description":"POSACONAZOLE DR 100 MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00085-4324-02","type":"NDC"}],"standard_charges":[{"minimum":71.12,"maximum":415.04,"gross_charge":508,"discounted_cash":116.34,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":269.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":415.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.12,"methodology":"fee schedule"}]}]},{"description":"PRAMIPEXOLE 0.125MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57237-0180-90","type":"NDC"}],"standard_charges":[{"minimum":13.78,"maximum":21.25,"gross_charge":26,"discounted_cash":5.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"}]}]},{"description":"PRAMIPEXOLE 0.125MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57237-0180-90","type":"NDC"}],"standard_charges":[{"minimum":3.64,"maximum":142.34,"gross_charge":26,"discounted_cash":5.96,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACET 1% 5ML OPS","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"11980-0180-05","type":"NDC"}],"standard_charges":[{"minimum":481.24,"maximum":741.84,"gross_charge":908,"discounted_cash":207.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":481.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.84,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACET 1% 5ML OPS","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"11980-0180-05","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":741.84,"gross_charge":908,"discounted_cash":207.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":481.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.12,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25MG SUPP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00713-0526-12","type":"NDC"}],"standard_charges":[{"minimum":80.03,"maximum":123.37,"gross_charge":151,"discounted_cash":34.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.37,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25MG SUPP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00713-0526-12","type":"NDC"}],"standard_charges":[{"minimum":21.14,"maximum":142.34,"gross_charge":151,"discounted_cash":34.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.14,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE FUM 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16714-0377-01","type":"NDC"}],"standard_charges":[{"minimum":31.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE FUM 100MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16714-0377-01","type":"NDC"}],"standard_charges":[{"minimum":8.26,"maximum":142.34,"gross_charge":59,"discounted_cash":13.52,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE FUM 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"29300-0147-01","type":"NDC"}],"standard_charges":[{"minimum":18.02,"maximum":27.78,"gross_charge":34,"discounted_cash":7.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE FUM 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"29300-0147-01","type":"NDC"}],"standard_charges":[{"minimum":4.76,"maximum":142.34,"gross_charge":34,"discounted_cash":7.79,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"}]}]},{"description":"RIFAXIMIN 550MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65649-0303-02","type":"NDC"}],"standard_charges":[{"minimum":191.33,"maximum":294.94,"gross_charge":361,"discounted_cash":82.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.94,"methodology":"fee schedule"}]}]},{"description":"RIFAXIMIN 550MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65649-0303-02","type":"NDC"}],"standard_charges":[{"minimum":50.54,"maximum":294.94,"gross_charge":361,"discounted_cash":82.67,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":191.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"}]}]},{"description":"RISPERIDONE 1MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50458-0300-01","type":"NDC"}],"standard_charges":[{"minimum":40.81,"maximum":62.91,"gross_charge":77,"discounted_cash":17.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"}]}]},{"description":"RISPERIDONE 1MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50458-0300-01","type":"NDC"}],"standard_charges":[{"minimum":10.78,"maximum":142.34,"gross_charge":77,"discounted_cash":17.64,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50458-0580-30","type":"NDC"}],"standard_charges":[{"minimum":51.94,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 10MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50458-0580-30","type":"NDC"}],"standard_charges":[{"minimum":13.72,"maximum":142.34,"gross_charge":98,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"}]}]},{"description":"SACUBITRIL/VALSART 24/26MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00078-0659-67","type":"NDC"}],"standard_charges":[{"minimum":46.11,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"}]}]},{"description":"SACUBITRIL/VALSART 24/26MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00078-0659-67","type":"NDC"}],"standard_charges":[{"minimum":12.18,"maximum":142.34,"gross_charge":87,"discounted_cash":19.93,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"}]}]},{"description":"SAXAGLIPTIN 2.5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65862-0825-30","type":"NDC"}],"standard_charges":[{"minimum":85.33,"maximum":131.54,"gross_charge":161,"discounted_cash":36.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":131.54,"methodology":"fee schedule"}]}]},{"description":"SAXAGLIPTIN 2.5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65862-0825-30","type":"NDC"}],"standard_charges":[{"minimum":22.54,"maximum":142.34,"gross_charge":161,"discounted_cash":36.87,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":131.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1.5MG/3DAY PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50742-0505-04","type":"NDC"}],"standard_charges":[{"minimum":91.16,"maximum":140.53,"gross_charge":172,"discounted_cash":39.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1.5MG/3DAY PATCH","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"50742-0505-04","type":"NDC"}],"standard_charges":[{"minimum":24.08,"maximum":142.34,"gross_charge":172,"discounted_cash":39.39,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":140.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.08,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 50MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00049-4900-41","type":"NDC"}],"standard_charges":[{"minimum":30.21,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 50MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00049-4900-41","type":"NDC"}],"standard_charges":[{"minimum":7.98,"maximum":142.34,"gross_charge":57,"discounted_cash":13.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1GM/10ML 10ML SUSP","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-7470-95","type":"NDC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1GM/10ML 10ML SUSP","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00904-7470-95","type":"NDC"}],"standard_charges":[{"minimum":12.88,"maximum":142.34,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00173-0735-00","type":"NDC"}],"standard_charges":[{"minimum":136.21,"maximum":209.97,"gross_charge":257,"discounted_cash":58.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.97,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 25MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00173-0735-00","type":"NDC"}],"standard_charges":[{"minimum":35.98,"maximum":209.97,"gross_charge":257,"discounted_cash":58.86,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":136.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"}]}]},{"description":"TAMSULOSIN 0.4MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57237-0014-01","type":"NDC"}],"standard_charges":[{"minimum":19.08,"maximum":29.42,"gross_charge":36,"discounted_cash":8.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"}]}]},{"description":"TAMSULOSIN 0.4MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"57237-0014-01","type":"NDC"}],"standard_charges":[{"minimum":5.04,"maximum":142.34,"gross_charge":36,"discounted_cash":8.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"}]}]},{"description":"TERBINAFINE 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"31722-0209-01","type":"NDC"}],"standard_charges":[{"minimum":59.36,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"}]}]},{"description":"TERBINAFINE 250MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"31722-0209-01","type":"NDC"}],"standard_charges":[{"minimum":15.68,"maximum":142.34,"gross_charge":112,"discounted_cash":25.65,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"}]}]},{"description":"TETRACAINE 0.5% 2ML OP SOL","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00065-0741-12","type":"NDC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"TETRACAINE 0.5% 2ML OP SOL","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00065-0741-12","type":"NDC"}],"standard_charges":[{"minimum":11.48,"maximum":142.34,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"}]}]},{"description":"TIMOLOL 0.25% 5ML OP SOL","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"70069-0701-01","type":"NDC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"TIMOLOL 0.25% 5ML OP SOL","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"70069-0701-01","type":"NDC"}],"standard_charges":[{"minimum":6.44,"maximum":142.34,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"}]}]},{"description":"TIMOLOL 0.5% 5ML OP SOL","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"64980-0514-05","type":"NDC"}],"standard_charges":[{"minimum":76.85,"maximum":118.47,"gross_charge":145,"discounted_cash":33.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":76.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.47,"methodology":"fee schedule"}]}]},{"description":"TIMOLOL 0.5% 5ML OP SOL","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"64980-0514-05","type":"NDC"}],"standard_charges":[{"minimum":20.3,"maximum":142.34,"gross_charge":145,"discounted_cash":33.21,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":76.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.3,"methodology":"fee schedule"}]}]},{"description":"TIOTROPIUM 18MCG INH 5 DOSES","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00597-0075-41","type":"NDC"}],"standard_charges":[{"minimum":328.6,"maximum":506.54,"gross_charge":620,"discounted_cash":141.98,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":328.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":506.54,"methodology":"fee schedule"}]}]},{"description":"TIOTROPIUM 18MCG INH 5 DOSES","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00597-0075-41","type":"NDC"}],"standard_charges":[{"minimum":86.8,"maximum":506.54,"gross_charge":620,"discounted_cash":141.98,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":328.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":506.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.8,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3% 5ML OP SOL","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72266-0196-01","type":"NDC"}],"standard_charges":[{"minimum":72.61,"maximum":111.93,"gross_charge":137,"discounted_cash":31.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3% 5ML OP SOL","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72266-0196-01","type":"NDC"}],"standard_charges":[{"minimum":19.18,"maximum":142.34,"gross_charge":137,"discounted_cash":31.38,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.18,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"59148-0020-50","type":"NDC"}],"standard_charges":[{"minimum":2675.97,"maximum":4125.04,"gross_charge":5049,"discounted_cash":1156.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2675.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4125.04,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"59148-0020-50","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":4125.04,"gross_charge":5049,"discounted_cash":1156.23,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2675.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4125.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.86,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 7.5MG TAB","drug_information": {"unit": 0.5,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"59148-0020-50","type":"NDC"}],"standard_charges":[{"minimum":646.07,"maximum":995.93,"gross_charge":1219,"discounted_cash":279.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":646.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":995.93,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 7.5MG TAB","drug_information": {"unit": 0.5,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"59148-0020-50","type":"NDC"}],"standard_charges":[{"minimum":106.77,"maximum":995.93,"gross_charge":1219,"discounted_cash":279.16,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":646.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":995.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.66,"methodology":"fee schedule"}]}]},{"description":"TRIAMCIN ACE 0.1% 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00168-0004-15","type":"NDC"}],"standard_charges":[{"minimum":25.44,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"TRIAMCIN ACE 0.1% 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00168-0004-15","type":"NDC"}],"standard_charges":[{"minimum":6.72,"maximum":142.34,"gross_charge":48,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"}]}]},{"description":"TRIAMCIN ACE 0.1% 454GM CRM","drug_information": {"unit": 454,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0064-05","type":"NDC"}],"standard_charges":[{"minimum":105.47,"maximum":162.59,"gross_charge":199,"discounted_cash":45.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.59,"methodology":"fee schedule"}]}]},{"description":"TRIAMCIN ACE 0.1% 454GM CRM","drug_information": {"unit": 454,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0064-05","type":"NDC"}],"standard_charges":[{"minimum":27.86,"maximum":162.59,"gross_charge":199,"discounted_cash":45.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.86,"methodology":"fee schedule"}]}]},{"description":"TRIAMCIN ACE 0.5% 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0065-35","type":"NDC"}],"standard_charges":[{"minimum":45.58,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"}]}]},{"description":"TRIAMCIN ACE 0.5% 15GM CRM","drug_information": {"unit": 15,"type": "GR"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"45802-0065-35","type":"NDC"}],"standard_charges":[{"minimum":12.04,"maximum":142.34,"gross_charge":86,"discounted_cash":19.7,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"}]}]},{"description":"TROPICAMIDE 1% 15ML OP SOL","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61314-0355-02","type":"NDC"}],"standard_charges":[{"minimum":214.65,"maximum":330.89,"gross_charge":405,"discounted_cash":92.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.89,"methodology":"fee schedule"}]}]},{"description":"TROPICAMIDE 1% 15ML OP SOL","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61314-0355-02","type":"NDC"}],"standard_charges":[{"minimum":56.7,"maximum":330.89,"gross_charge":405,"discounted_cash":92.75,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"}]}]},{"description":"TROPICAMIDE 1% 3ML OP SOL","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61314-0355-01","type":"NDC"}],"standard_charges":[{"minimum":63.6,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"}]}]},{"description":"TROPICAMIDE 1% 3ML OP SOL","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"61314-0355-01","type":"NDC"}],"standard_charges":[{"minimum":16.8,"maximum":142.34,"gross_charge":120,"discounted_cash":27.48,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00173-0933-08","type":"NDC"}],"standard_charges":[{"minimum":36.57,"maximum":56.38,"gross_charge":69,"discounted_cash":15.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00173-0933-08","type":"NDC"}],"standard_charges":[{"minimum":9.66,"maximum":142.34,"gross_charge":69,"discounted_cash":15.81,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 125MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42494-0450-20","type":"NDC"}],"standard_charges":[{"minimum":141.51,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 125MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42494-0450-20","type":"NDC"}],"standard_charges":[{"minimum":37.38,"maximum":218.14,"gross_charge":267,"discounted_cash":61.15,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":141.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":218.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.38,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 125MG/5ML SUS","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65628-0204-05","type":"NDC"}],"standard_charges":[{"minimum":37.1,"maximum":57.19,"gross_charge":70,"discounted_cash":16.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 125MG/5ML SUS","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65628-0204-05","type":"NDC"}],"standard_charges":[{"minimum":9.8,"maximum":142.34,"gross_charge":70,"discounted_cash":16.03,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"}]}]},{"description":"VIT D(ERGOCALCIF) 50000IU CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42806-0547-01","type":"NDC"}],"standard_charges":[{"minimum":9.01,"maximum":13.89,"gross_charge":17,"discounted_cash":3.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"}]}]},{"description":"VIT D(ERGOCALCIF) 50000IU CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"42806-0547-01","type":"NDC"}],"standard_charges":[{"minimum":2.38,"maximum":142.34,"gross_charge":17,"discounted_cash":3.9,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72578-0063-06","type":"NDC"}],"standard_charges":[{"minimum":358.28,"maximum":552.3,"gross_charge":676,"discounted_cash":154.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":358.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":552.3,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"72578-0063-06","type":"NDC"}],"standard_charges":[{"minimum":94.64,"maximum":552.3,"gross_charge":676,"discounted_cash":154.81,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":358.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":552.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.64,"methodology":"fee schedule"}]}]},{"description":"ZOLPIDEM TART 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16714-0621-01","type":"NDC"}],"standard_charges":[{"minimum":21.2,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"}]}]},{"description":"ZOLPIDEM TART 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"A9270","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"16714-0621-01","type":"NDC"}],"standard_charges":[{"minimum":5.6,"maximum":142.34,"gross_charge":40,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"MEBROFENIN DX TO 15MCI","code_information":[{"code":"A9537","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":46.11,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"}]}]},{"description":"MEBROFENIN DX TO 15MCI","code_information":[{"code":"A9537","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":46.11,"maximum":129.65,"gross_charge":87,"discounted_cash":19.93,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":97.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":97.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":98.74,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.91,"methodology":"fee schedule"}]}]},{"description":"PENTETATE DX UP TO 25MCI","code_information":[{"code":"A9539","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"PENTETATE DX UP TO 25MCI","code_information":[{"code":"A9539","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":55.93,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"}]}]},{"description":"MACROAG ALBUM DX TO 10MCI","code_information":[{"code":"A9540","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":31.87,"gross_charge":39,"discounted_cash":8.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"}]}]},{"description":"MACROAG ALBUM DX TO 10MCI","code_information":[{"code":"A9540","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":70.3,"gross_charge":39,"discounted_cash":8.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":52.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":52.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"}]}]},{"description":"SULF COLL TC99M <=20MCI W MEAL","code_information":[{"code":"A9541","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":101.76,"maximum":156.87,"gross_charge":192,"discounted_cash":43.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.87,"methodology":"fee schedule"}]}]},{"description":"SULF COLL TC99M <=20MCI W MEAL","code_information":[{"code":"A9541","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":101.76,"maximum":626.7,"gross_charge":192,"discounted_cash":43.97,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":470.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":470.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":477.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":101.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.05,"methodology":"fee schedule"}]}]},{"description":"IND IN-111 PENTETATE DX 0.5MCI","code_information":[{"code":"A9548","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1145.33,"maximum":1765.54,"gross_charge":2161,"discounted_cash":494.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1145.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1765.54,"methodology":"fee schedule"}]}]},{"description":"IND IN-111 PENTETATE DX 0.5MCI","code_information":[{"code":"A9548","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":762.37,"maximum":1976.72,"gross_charge":2161,"discounted_cash":494.87,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1976.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1482.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1482.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1580.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1580.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1145.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1765.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":907.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":907.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":907.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":762.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":770,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":785.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":777.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":762.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":762.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":762.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":781.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":762.37,"methodology":"fee schedule"}]}]},{"description":"MERTIATIDE DX TO 15MCI","code_information":[{"code":"A9562","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1574.1,"maximum":2426.49,"gross_charge":2970,"discounted_cash":680.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1574.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2426.49,"methodology":"fee schedule"}]}]},{"description":"MERTIATIDE DX TO 15MCI","code_information":[{"code":"A9562","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":905.32,"maximum":2426.49,"gross_charge":2970,"discounted_cash":680.13,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1815.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1362.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1362.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1574.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2426.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":905.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":905.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":905.32,"methodology":"fee schedule"}]}]},{"description":"PENTETATE DX AEROSOL TO 75MCI","code_information":[{"code":"A9567","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1350.44,"maximum":2081.72,"gross_charge":2548,"discounted_cash":583.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1350.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2081.72,"methodology":"fee schedule"}]}]},{"description":"PENTETATE DX AEROSOL TO 75MCI","code_information":[{"code":"A9567","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":30.31,"maximum":2081.72,"gross_charge":2548,"discounted_cash":583.5,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1350.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2081.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.72,"methodology":"fee schedule"}]}]},{"description":"GADOTERATE MEG 10MMOL/20ML INJ","code_information":[{"code":"A9575","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"GADOTERATE MEG 10MMOL/20ML INJ","code_information":[{"code":"A9575","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"GADOTERIDOL 279MG 1ML INJ","code_information":[{"code":"A9576","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":63.6,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"}]}]},{"description":"GADOTERIDOL 279MG 1ML INJ","code_information":[{"code":"A9576","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.5,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"}]}]},{"description":"GADOTERIDOL 279/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1111-16","type":"NDC"}],"standard_charges":[{"minimum":314.82,"maximum":485.3,"gross_charge":594,"discounted_cash":136.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":314.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":485.3,"methodology":"fee schedule"}]}]},{"description":"GADOTERIDOL 279/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1111-16","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":485.3,"gross_charge":594,"discounted_cash":136.03,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":314.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":485.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"GADOTERIDOL 279/ML 15ML INJ","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1111-02","type":"NDC"}],"standard_charges":[{"minimum":460.57,"maximum":709.98,"gross_charge":869,"discounted_cash":199.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":460.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":709.98,"methodology":"fee schedule"}]}]},{"description":"GADOTERIDOL 279/ML 15ML INJ","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1111-02","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":709.98,"gross_charge":869,"discounted_cash":199.01,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":460.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":709.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"GADOTERIDOL 279/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1111-03","type":"NDC"}],"standard_charges":[{"minimum":568.69,"maximum":876.65,"gross_charge":1073,"discounted_cash":245.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":568.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":876.65,"methodology":"fee schedule"}]}]},{"description":"GADOTERIDOL 279/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1111-03","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":876.65,"gross_charge":1073,"discounted_cash":245.72,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":568.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":876.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"GADOXETATE PER 1ML 10ML SDV","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9581","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50419-0320-05","type":"NDC"}],"standard_charges":[{"minimum":738.29,"maximum":1138.09,"gross_charge":1393,"discounted_cash":319,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":738.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1138.09,"methodology":"fee schedule"}]}]},{"description":"GADOXETATE PER 1ML 10ML SDV","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"A9581","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50419-0320-05","type":"NDC"}],"standard_charges":[{"minimum":15.07,"maximum":1138.09,"gross_charge":1393,"discounted_cash":319,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":25.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":738.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1138.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"}]}]},{"description":"GADOBUTROL 1MMOL/ML 10ML SDV","code_information":[{"code":"A9585","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"}]}]},{"description":"GADOBUTROL 1MMOL/ML 10ML SDV","code_information":[{"code":"A9585","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.29,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"GADOBUTROL 1MMOL/ML 7.5ML SDV","drug_information": {"unit": 7.5,"type": "ML"},"code_information":[{"code":"A9585","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50419-0325-11","type":"NDC"}],"standard_charges":[{"minimum":336.55,"maximum":518.8,"gross_charge":635,"discounted_cash":145.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":336.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":518.8,"methodology":"fee schedule"}]}]},{"description":"GADOBUTROL 1MMOL/ML 7.5ML SDV","drug_information": {"unit": 7.5,"type": "ML"},"code_information":[{"code":"A9585","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50419-0325-11","type":"NDC"}],"standard_charges":[{"minimum":0.29,"maximum":518.8,"gross_charge":635,"discounted_cash":145.42,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":336.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":518.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 10-13","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":25.44,"maximum":39.22,"gross_charge":48,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 10-13","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":6.72,"maximum":810.57,"gross_charge":48,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.4,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.42,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 115X-150","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":283.55,"maximum":437.1,"gross_charge":535,"discounted_cash":122.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 115X-150","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":74.9,"maximum":810.57,"gross_charge":535,"discounted_cash":122.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 1234X-1605","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3039.55,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 1234X-1605","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":883.19,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":883.19,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1244.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1244.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 13X-17","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":32.33,"maximum":49.84,"gross_charge":61,"discounted_cash":13.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 13X-17","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":8.54,"maximum":810.57,"gross_charge":61,"discounted_cash":13.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.4,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.24,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 150X-195","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 150X-195","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":97.58,"maximum":810.57,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 1605X-2087","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3952.74,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 1605X-2087","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1618.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1618.39,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 17X-23","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":42.93,"maximum":66.18,"gross_charge":81,"discounted_cash":18.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 17X-23","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":11.34,"maximum":810.57,"gross_charge":81,"discounted_cash":18.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.58,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 195X-254","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 195X-254","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.98,"maximum":810.57,"gross_charge":907,"discounted_cash":207.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 2087X-2714","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3180.53,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 2087X-2714","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 23X-30","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":56.71,"maximum":87.42,"gross_charge":107,"discounted_cash":24.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.42,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 23X-30","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":14.98,"maximum":810.57,"gross_charge":107,"discounted_cash":24.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 254X-331","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 254X-331","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 2714X-3529","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4136.12,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 2714X-3529","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 30X-39","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 30X-39","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":19.46,"maximum":810.57,"gross_charge":139,"discounted_cash":31.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 331X-431","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":815.67,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 331X-431","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":215.46,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 3529X-4588","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5377.38,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 3529X-4588","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.49,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1562.49,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2201.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2201.69,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 39X-51","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 39X-51","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":25.48,"maximum":810.57,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 431X-561","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1062.12,"maximum":1637.27,"gross_charge":2004,"discounted_cash":458.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 431X-561","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":280.56,"maximum":1637.27,"gross_charge":2004,"discounted_cash":458.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 4588X-5965","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":10589.4,"maximum":16323.66,"gross_charge":19980,"discounted_cash":4575.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10589.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16323.66,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 4588X-5965","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":16323.66,"gross_charge":19980,"discounted_cash":4575.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3076.92,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3076.92,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4335.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4335.66,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10589.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16323.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2797.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2797.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2797.2,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 51X-67","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.14,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 51X-67","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":33.32,"maximum":810.57,"gross_charge":238,"discounted_cash":54.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.66,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":51.65,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 561X-730","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1382.24,"maximum":2130.74,"gross_charge":2608,"discounted_cash":597.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 561X-730","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":365.12,"maximum":2130.74,"gross_charge":2608,"discounted_cash":597.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 67X-88","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.89,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 67X-88","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":43.82,"maximum":810.57,"gross_charge":313,"discounted_cash":71.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.21,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.21,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.93,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 730X-949","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1797.76,"maximum":2771.27,"gross_charge":3392,"discounted_cash":776.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 730X-949","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":474.88,"maximum":2771.27,"gross_charge":3392,"discounted_cash":776.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 7755X-10082","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":17490,"maximum":26961,"gross_charge":33000,"discounted_cash":7557,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17490,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26961,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 7755X-10082","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":26961,"gross_charge":33000,"discounted_cash":7557,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5082,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5082,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7161,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":7161,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17490,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26961,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4620,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4620,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4620,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 88X-115","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":217.3,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 88X-115","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.4,"maximum":810.57,"gross_charge":410,"discounted_cash":93.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 949X-1234","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2337.3,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"}]}]},{"description":"ANCHOR/SCREW 949X-1234","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"}]}]},{"description":"BONE SUBSTITUTE 331X-431","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":720.8,"maximum":1111.12,"gross_charge":1360,"discounted_cash":311.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":720.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1111.12,"methodology":"fee schedule"}]}]},{"description":"BONE SUBSTITUTE 331X-431","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":190.4,"maximum":1111.12,"gross_charge":1360,"discounted_cash":311.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.44,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":295.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":295.12,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":720.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1111.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.4,"methodology":"fee schedule"}]}]},{"description":"BONE SUBSTITUTE 4588X-5965","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":10074.24,"maximum":15529.54,"gross_charge":19008,"discounted_cash":4352.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10074.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15529.54,"methodology":"fee schedule"}]}]},{"description":"BONE SUBSTITUTE 4588X-5965","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":608.03,"maximum":15529.54,"gross_charge":19008,"discounted_cash":4352.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2927.24,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2927.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4124.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4124.74,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10074.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15529.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2661.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2661.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2661.12,"methodology":"fee schedule"}]}]},{"description":"BONE SUBSTITUTE 67X-88","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":287.79,"maximum":443.64,"gross_charge":543,"discounted_cash":124.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"}]}]},{"description":"BONE SUBSTITUTE 67X-88","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":76.02,"maximum":810.57,"gross_charge":543,"discounted_cash":124.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.63,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":608.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":117.84,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"}]}]},{"description":"CATH PTA NLASR 254X-331","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1343.02,"maximum":2070.28,"gross_charge":2534,"discounted_cash":580.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2070.28,"methodology":"fee schedule"}]}]},{"description":"CATH PTA NLASR 254X-331","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":332.1,"maximum":2070.28,"gross_charge":2534,"discounted_cash":580.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.24,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":390.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":549.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":549.88,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2070.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.76,"methodology":"fee schedule"}]}]},{"description":"CATH NONVAS DIL 150X-195","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"CATH NONVAS DIL 150X-195","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":97.58,"maximum":1960.19,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1960.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"}]}]},{"description":"CATH NONVAS DIL 195X-254","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"CATH NONVAS DIL 195X-254","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.98,"maximum":1960.19,"gross_charge":907,"discounted_cash":207.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1960.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"}]}]},{"description":"CATH NONVAS DIL 254X-331","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1343.02,"maximum":2070.28,"gross_charge":2534,"discounted_cash":580.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2070.28,"methodology":"fee schedule"}]}]},{"description":"CATH NONVAS DIL 254X-331","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":354.76,"maximum":2070.28,"gross_charge":2534,"discounted_cash":580.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.24,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":390.24,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1960.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":549.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":549.88,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2070.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.76,"methodology":"fee schedule"}]}]},{"description":"CATH NONVAS DIL 331X-431","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":815.67,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"}]}]},{"description":"CATH NONVAS DIL 331X-431","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":215.46,"maximum":1960.19,"gross_charge":1539,"discounted_cash":352.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1960.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"}]}]},{"description":"CATH NVAS DISCT 195X-254","code_information":[{"code":"C1727","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":713.91,"maximum":1100.5,"gross_charge":1347,"discounted_cash":308.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":713.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1100.5,"methodology":"fee schedule"}]}]},{"description":"CATH NVAS DISCT 195X-254","code_information":[{"code":"C1727","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":188.58,"maximum":1100.5,"gross_charge":1347,"discounted_cash":308.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.44,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":723.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":542.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":542.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":292.3,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":713.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1100.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE <10","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE <10","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.2,"maximum":190.54,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 13X-17","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":63.6,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 13X-17","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.8,"maximum":190.54,"gross_charge":120,"discounted_cash":27.48,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 17X-23","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":84.8,"maximum":130.72,"gross_charge":160,"discounted_cash":36.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 17X-23","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.4,"maximum":190.54,"gross_charge":160,"discounted_cash":36.64,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":130.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 23X-30","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 23X-30","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.54,"maximum":190.54,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 39X-51","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":190.8,"maximum":294.12,"gross_charge":360,"discounted_cash":82.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 39X-51","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":50.4,"maximum":294.12,"gross_charge":360,"discounted_cash":82.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 51X-67","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":129.85,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 51X-67","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":34.3,"maximum":200.17,"gross_charge":245,"discounted_cash":56.11,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":129.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.3,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 67X-88","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":287.79,"maximum":443.64,"gross_charge":543,"discounted_cash":124.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 67X-88","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":76.02,"maximum":443.64,"gross_charge":543,"discounted_cash":124.35,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.02,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 88X-115","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":322.77,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"}]}]},{"description":"CATH DRAINAGE 88X-115","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":85.26,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":142.93,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPE UGI 2714X-3529","code_information":[{"code":"C1748","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":14332.26,"maximum":22093.32,"gross_charge":27042,"discounted_cash":6192.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14332.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22093.32,"methodology":"fee schedule"}]}]},{"description":"ENDOSCOPE UGI 2714X-3529","code_information":[{"code":"C1748","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1026.23,"maximum":22093.32,"gross_charge":27042,"discounted_cash":6192.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4164.47,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4164.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1026.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5868.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5868.12,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14332.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22093.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3785.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3785.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3785.88,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYS LT 195X-254","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYS LT 195X-254","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.98,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":569.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":427.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":427.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYS LT 254X-331","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYS LT 254X-331","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":569.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":427.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":427.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYS LT 51X-67","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":137.8,"maximum":212.42,"gross_charge":260,"discounted_cash":59.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYS LT 51X-67","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":36.4,"maximum":569.57,"gross_charge":260,"discounted_cash":59.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.04,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.04,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":569.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":427.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":427.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":56.42,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 10-13","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":24.38,"maximum":37.59,"gross_charge":46,"discounted_cash":10.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 10-13","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":6.44,"maximum":291.64,"gross_charge":46,"discounted_cash":10.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.09,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.09,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9.99,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 17X-23","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":42.93,"maximum":66.18,"gross_charge":81,"discounted_cash":18.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 17X-23","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":11.34,"maximum":291.64,"gross_charge":81,"discounted_cash":18.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.58,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 195X-254","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":498.2,"maximum":767.98,"gross_charge":940,"discounted_cash":215.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":498.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":767.98,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 195X-254","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":131.6,"maximum":767.98,"gross_charge":940,"discounted_cash":215.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.76,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.76,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":203.98,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":498.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":767.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 254X-331","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":580.35,"maximum":894.62,"gross_charge":1095,"discounted_cash":250.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":580.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":894.62,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 254X-331","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":153.3,"maximum":894.62,"gross_charge":1095,"discounted_cash":250.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.63,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.63,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":237.62,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":580.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":894.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.3,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 331X-431","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":815.67,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 331X-431","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":215.46,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 51X-67","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":218.89,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 51X-67","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.82,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.61,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":89.63,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 88X-115","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":217.3,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"}]}]},{"description":"CATH INFUSION 88X-115","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.4,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYSIS ST 195X-254","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":417.64,"maximum":643.8,"gross_charge":788,"discounted_cash":180.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":643.8,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYSIS ST 195X-254","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":110.32,"maximum":643.8,"gross_charge":788,"discounted_cash":180.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.36,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.36,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":171,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":643.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.32,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYSIS ST 51X-67","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":122.96,"maximum":189.55,"gross_charge":232,"discounted_cash":53.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":122.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.55,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYSIS ST 51X-67","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":32.48,"maximum":291.64,"gross_charge":232,"discounted_cash":53.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.73,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.73,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.35,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":122.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.48,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYSIS ST 88X-115","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":217.3,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"}]}]},{"description":"CATH DIALYSIS ST 88X-115","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.4,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":218.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL <10","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":21.2,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL <10","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5.6,"maximum":114.03,"gross_charge":40,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.68,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL 13X-17","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":27.56,"maximum":42.49,"gross_charge":52,"discounted_cash":11.91,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL 13X-17","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":7.28,"maximum":114.03,"gross_charge":52,"discounted_cash":11.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.29,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL 30X-39","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":75.79,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL 30X-39","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":20.02,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":31.04,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.02,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL 39X-51","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL 39X-51","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":25.48,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL 51X-67","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.14,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"}]}]},{"description":"CATH URETERAL 51X-67","code_information":[{"code":"C1758","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":33.32,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.66,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":85.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":51.65,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 1234X-1605","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3039.55,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 1234X-1605","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":802.9,"maximum":5329.2,"gross_charge":5735,"discounted_cash":1313.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":883.19,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":883.19,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1244.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1244.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 1605X-2087","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3952.74,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 1605X-2087","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1044.12,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1618.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1618.39,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 2087X-2714","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3180.53,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 2087X-2714","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":840.14,"maximum":5329.2,"gross_charge":6001,"discounted_cash":1374.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 2714X-3529","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4136.12,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 2714X-3529","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1092.56,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 39X-51","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":95.4,"maximum":147.06,"gross_charge":180,"discounted_cash":41.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 39X-51","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":25.2,"maximum":5329.2,"gross_charge":180,"discounted_cash":41.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.72,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.06,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 431X-561","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1038.8,"maximum":1601.32,"gross_charge":1960,"discounted_cash":448.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1038.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1601.32,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 431X-561","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":274.4,"maximum":5329.2,"gross_charge":1960,"discounted_cash":448.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":301.84,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":301.84,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":425.32,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1038.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1601.32,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.4,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 561X-730","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1382.24,"maximum":2130.74,"gross_charge":2608,"discounted_cash":597.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 561X-730","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":365.12,"maximum":5329.2,"gross_charge":2608,"discounted_cash":597.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 730X-949","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1797.76,"maximum":2771.27,"gross_charge":3392,"discounted_cash":776.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 730X-949","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":474.88,"maximum":5329.2,"gross_charge":3392,"discounted_cash":776.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 7755X-10082","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":20358.36,"maximum":31382.61,"gross_charge":38412,"discounted_cash":8796.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20358.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31382.61,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 7755X-10082","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3997.57,"maximum":31382.61,"gross_charge":38412,"discounted_cash":8796.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5915.45,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5915.45,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8335.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8335.41,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20358.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31382.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5377.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5377.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5377.68,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 949X-1234","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2337.3,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM 949X-1234","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":617.4,"maximum":5329.2,"gross_charge":4410,"discounted_cash":1009.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM11090X-12199","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":15428.83,"maximum":23783.69,"gross_charge":29111,"discounted_cash":6666.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15428.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23783.69,"methodology":"fee schedule"}]}]},{"description":"CONN TISS HUM11090X-12199","code_information":[{"code":"C1762","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3997.57,"maximum":23783.69,"gross_charge":29111,"discounted_cash":6666.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4483.1,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4483.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5329.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3997.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6317.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6317.09,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15428.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23783.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4075.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4075.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4075.54,"methodology":"fee schedule"}]}]},{"description":"CONN TISS NHUM 1605X-2087","code_information":[{"code":"C1763","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3952.74,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"}]}]},{"description":"CONN TISS NHUM 1605X-2087","code_information":[{"code":"C1763","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1044.12,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5004.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3753.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3753.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1618.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1618.39,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"}]}]},{"description":"CONN TISS NHUM 2714X-3529","code_information":[{"code":"C1763","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4136.12,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"CONN TISS NHUM 2714X-3529","code_information":[{"code":"C1763","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1092.56,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5004.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3753.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3753.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"}]}]},{"description":"CONN TISS NHUM 949X-1234","code_information":[{"code":"C1763","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2337.3,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"}]}]},{"description":"CONN TISS NHUM 949X-1234","code_information":[{"code":"C1763","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":617.4,"maximum":5004.14,"gross_charge":4410,"discounted_cash":1009.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5004.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3753.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3753.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"}]}]},{"description":"ADHESION BARR 254X-331","code_information":[{"code":"C1765","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"ADHESION BARR 254X-331","code_information":[{"code":"C1765","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":714.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":535.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":535.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"NEURSTM NREC 7755X-10082","code_information":[{"code":"C1767","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":22260,"maximum":34314,"gross_charge":42000,"discounted_cash":9618,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22260,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34314,"methodology":"fee schedule"}]}]},{"description":"NEURSTM NREC 7755X-10082","code_information":[{"code":"C1767","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5880,"maximum":51402,"gross_charge":42000,"discounted_cash":9618,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6468,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6468,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51402,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":38558,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":38558,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9114,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9114,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22260,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34314,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5880,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5880,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5880,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE <10","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":21.2,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE <10","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5.6,"maximum":906.37,"gross_charge":40,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.68,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 10-13","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 10-13","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":906.37,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.17,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 115X-150","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":301.04,"maximum":464.06,"gross_charge":568,"discounted_cash":130.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":301.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":464.06,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 115X-150","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":79.52,"maximum":906.37,"gross_charge":568,"discounted_cash":130.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":123.26,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":301.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":464.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.52,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 150X-195","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 150X-195","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":97.58,"maximum":906.37,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 195X-254","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":713.91,"maximum":1100.5,"gross_charge":1347,"discounted_cash":308.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":713.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1100.5,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 195X-254","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":188.58,"maximum":1100.5,"gross_charge":1347,"discounted_cash":308.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.44,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.44,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":292.3,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":713.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1100.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.58,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 23X-30","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":56.71,"maximum":87.42,"gross_charge":107,"discounted_cash":24.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.42,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 23X-30","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":14.98,"maximum":906.37,"gross_charge":107,"discounted_cash":24.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 254X-331","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 254X-331","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 30X-39","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 30X-39","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":19.46,"maximum":906.37,"gross_charge":139,"discounted_cash":31.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 39X-51","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 39X-51","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":25.48,"maximum":906.37,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 51X-67","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":218.89,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 51X-67","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.82,"maximum":906.37,"gross_charge":413,"discounted_cash":94.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.61,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":89.63,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 67X-88","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":159,"maximum":245.1,"gross_charge":300,"discounted_cash":68.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 67X-88","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":42,"maximum":906.37,"gross_charge":300,"discounted_cash":68.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.2,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.2,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":65.1,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":245.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 88X-115","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":217.3,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"}]}]},{"description":"GUIDEWIRE 88X-115","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.4,"maximum":906.37,"gross_charge":410,"discounted_cash":93.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":679.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"}]}]},{"description":"URO DVC W SLING1234X-1605","code_information":[{"code":"C1771","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3385.64,"maximum":5219,"gross_charge":6388,"discounted_cash":1462.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3385.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5219,"methodology":"fee schedule"}]}]},{"description":"URO DVC W SLING1234X-1605","code_information":[{"code":"C1771","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":894.32,"maximum":9150.97,"gross_charge":6388,"discounted_cash":1462.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":983.76,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":983.76,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9150.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6864.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6864.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1386.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1386.2,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3385.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5219,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.32,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 115X-150","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":283.55,"maximum":437.1,"gross_charge":535,"discounted_cash":122.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 115X-150","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":74.9,"maximum":4438.79,"gross_charge":535,"discounted_cash":122.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 1234X-1605","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3039.55,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 1234X-1605","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":802.9,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":883.19,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":883.19,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1244.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1244.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 150X-195","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":371,"maximum":571.9,"gross_charge":700,"discounted_cash":160.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":371,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":571.9,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 150X-195","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":98,"maximum":4438.79,"gross_charge":700,"discounted_cash":160.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.9,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":371,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":571.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":98,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 1605X-2087","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3952.74,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 1605X-2087","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1044.12,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1618.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1618.39,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1044.12,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 195X-254","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":530,"maximum":817,"gross_charge":1000,"discounted_cash":229,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":530,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":817,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 195X-254","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":140,"maximum":4438.79,"gross_charge":1000,"discounted_cash":229,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":530,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":817,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 2087X-2714","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3180.53,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 2087X-2714","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":840.14,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 254X-331","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 254X-331","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":4438.79,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 2714X-3529","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4136.12,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 2714X-3529","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1092.56,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 28764X-31640","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":65147.6,"maximum":100425.64,"gross_charge":122920,"discounted_cash":28148.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65147.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100425.64,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 28764X-31640","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3329.66,"maximum":100425.64,"gross_charge":122920,"discounted_cash":28148.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18929.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18929.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26673.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":26673.64,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65147.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100425.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17208.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17208.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17208.8,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 331X-431","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":815.67,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 331X-431","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":215.46,"maximum":4438.79,"gross_charge":1539,"discounted_cash":352.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 3529X-4588","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5377.38,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 3529X-4588","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1420.44,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.49,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1562.49,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2201.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2201.69,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 39X-51","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 39X-51","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":28,"maximum":4438.79,"gross_charge":200,"discounted_cash":45.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":43.4,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 431X-561","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1062.12,"maximum":1637.27,"gross_charge":2004,"discounted_cash":458.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 431X-561","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":280.56,"maximum":4438.79,"gross_charge":2004,"discounted_cash":458.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 4588X-5965","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":12296,"maximum":18954.4,"gross_charge":23200,"discounted_cash":5312.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12296,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18954.4,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 4588X-5965","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3248,"maximum":18954.4,"gross_charge":23200,"discounted_cash":5312.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3572.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3572.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5034.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5034.4,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12296,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18954.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3248,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3248,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3248,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 561X-730","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1382.24,"maximum":2130.74,"gross_charge":2608,"discounted_cash":597.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 561X-730","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":365.12,"maximum":4438.79,"gross_charge":2608,"discounted_cash":597.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 5965X-7755","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":14688.42,"maximum":22642.34,"gross_charge":27714,"discounted_cash":6346.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14688.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22642.34,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 5965X-7755","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3329.66,"maximum":22642.34,"gross_charge":27714,"discounted_cash":6346.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4267.96,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4267.96,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6013.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6013.94,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14688.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22642.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3879.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3879.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3879.96,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 730X-949","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1797.76,"maximum":2771.27,"gross_charge":3392,"discounted_cash":776.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 730X-949","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":474.88,"maximum":4438.79,"gross_charge":3392,"discounted_cash":776.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 7755X-10082","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":16781.92,"maximum":25869.49,"gross_charge":31664,"discounted_cash":7251.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16781.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25869.49,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 7755X-10082","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3329.66,"maximum":25869.49,"gross_charge":31664,"discounted_cash":7251.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4876.26,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4876.26,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6871.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6871.09,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16781.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25869.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4432.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4432.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4432.96,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 88X-115","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":212,"maximum":326.8,"gross_charge":400,"discounted_cash":91.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":212,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":326.8,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 88X-115","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":56,"maximum":4438.79,"gross_charge":400,"discounted_cash":91.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.6,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":86.8,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":212,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":326.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 949X-1234","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2337.3,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"}]}]},{"description":"JOINT DEVICE 949X-1234","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":617.4,"maximum":4438.79,"gross_charge":4410,"discounted_cash":1009.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4438.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3329.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"}]}]},{"description":"LEAD NEUROSTIM 195X-254","code_information":[{"code":"C1778","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"LEAD NEUROSTIM 195X-254","code_information":[{"code":"C1778","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.98,"maximum":4502.26,"gross_charge":907,"discounted_cash":207.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4502.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3377.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3377.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"}]}]},{"description":"LEAD NEUROSTIM 2087X-2714","code_information":[{"code":"C1778","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5724,"maximum":8823.6,"gross_charge":10800,"discounted_cash":2473.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5724,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8823.6,"methodology":"fee schedule"}]}]},{"description":"LEAD NEUROSTIM 2087X-2714","code_information":[{"code":"C1778","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1512,"maximum":8823.6,"gross_charge":10800,"discounted_cash":2473.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1663.2,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1663.2,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4502.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3377.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3377.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2343.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2343.6,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5724,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8823.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1512,"methodology":"fee schedule"}]}]},{"description":"LEAD NEUROSTIM 2714X-3529","code_information":[{"code":"C1778","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4136.12,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"LEAD NEUROSTIM 2714X-3529","code_information":[{"code":"C1778","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1092.56,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4502.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3377.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3377.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 11090X-12199","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":23797,"maximum":36683.3,"gross_charge":44900,"discounted_cash":10282.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23797,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36683.3,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 11090X-12199","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2495.2,"maximum":36683.3,"gross_charge":44900,"discounted_cash":10282.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6914.6,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6914.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9743.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9743.3,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":23797,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36683.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6286,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6286,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6286,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 115X-150","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":307.4,"maximum":473.86,"gross_charge":580,"discounted_cash":132.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":307.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":473.86,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 115X-150","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":81.2,"maximum":3326.38,"gross_charge":580,"discounted_cash":132.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.32,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":125.86,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":307.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":473.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.2,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 1234X-1605","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3039.55,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 1234X-1605","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":802.9,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":883.19,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":883.19,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1244.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1244.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.9,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 150X-195","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 150X-195","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":97.58,"maximum":3326.38,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 1605X-2087","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4240,"maximum":6536,"gross_charge":8000,"discounted_cash":1832,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4240,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6536,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 1605X-2087","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1120,"maximum":6536,"gross_charge":8000,"discounted_cash":1832,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1232,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1232,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1736,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1736,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4240,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6536,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 16237X-17861","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2480.4,"maximum":3823.56,"gross_charge":4680,"discounted_cash":1071.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2480.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3823.56,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 16237X-17861","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":655.2,"maximum":3823.56,"gross_charge":4680,"discounted_cash":1071.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":720.72,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":720.72,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.56,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2480.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3823.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.2,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 195X-254","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 195X-254","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.98,"maximum":3326.38,"gross_charge":907,"discounted_cash":207.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 2087X-2714","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5157.96,"maximum":7951.05,"gross_charge":9732,"discounted_cash":2228.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5157.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7951.05,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 2087X-2714","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1362.48,"maximum":7951.05,"gross_charge":9732,"discounted_cash":2228.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1498.73,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1498.73,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2111.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2111.85,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5157.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7951.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.48,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 21611X-23772","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":30066.37,"maximum":46347.6,"gross_charge":56729,"discounted_cash":12990.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30066.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46347.6,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 21611X-23772","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2495.2,"maximum":46347.6,"gross_charge":56729,"discounted_cash":12990.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8736.27,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8736.27,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12310.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":12310.2,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30066.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46347.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7942.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7942.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7942.06,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 254X-331","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 254X-331","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":3326.38,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 30X-39","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 30X-39","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":19.46,"maximum":3326.38,"gross_charge":139,"discounted_cash":31.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 331X-431","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":815.67,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 331X-431","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":215.46,"maximum":3326.38,"gross_charge":1539,"discounted_cash":352.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 39X-51","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":90.63,"maximum":139.71,"gross_charge":171,"discounted_cash":39.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 39X-51","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":23.94,"maximum":3326.38,"gross_charge":171,"discounted_cash":39.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.11,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 431X-561","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1062.12,"maximum":1637.27,"gross_charge":2004,"discounted_cash":458.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 431X-561","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":280.56,"maximum":3326.38,"gross_charge":2004,"discounted_cash":458.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 561X-730","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1382.24,"maximum":2130.74,"gross_charge":2608,"discounted_cash":597.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 561X-730","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":365.12,"maximum":3326.38,"gross_charge":2608,"discounted_cash":597.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":401.64,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":565.94,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1382.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.12,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 67X-88","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.89,"maximum":255.73,"gross_charge":313,"discounted_cash":71.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 67X-88","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":43.82,"maximum":3326.38,"gross_charge":313,"discounted_cash":71.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.21,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.21,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.93,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":165.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":255.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 730X-949","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1797.76,"maximum":2771.27,"gross_charge":3392,"discounted_cash":776.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 730X-949","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":474.88,"maximum":3326.38,"gross_charge":3392,"discounted_cash":776.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 88X-115","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":217.3,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 88X-115","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.4,"maximum":3326.38,"gross_charge":410,"discounted_cash":93.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 949X-1234","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2337.3,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"}]}]},{"description":"MESH IMP 949X-1234","code_information":[{"code":"C1781","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":617.4,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2495.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"}]}]},{"description":"MORCELLATOR 730X-949","code_information":[{"code":"C1782","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2224.94,"maximum":3429.77,"gross_charge":4198,"discounted_cash":961.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2224.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3429.77,"methodology":"fee schedule"}]}]},{"description":"MORCELLATOR 730X-949","code_information":[{"code":"C1782","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":587.72,"maximum":3429.77,"gross_charge":4198,"discounted_cash":961.35,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2146.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1609.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1609.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2224.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3429.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.72,"methodology":"fee schedule"}]}]},{"description":"NEUROSTIM PROG 1234X-1605","code_information":[{"code":"C1787","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3180,"maximum":4902,"gross_charge":6000,"discounted_cash":1374,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902,"methodology":"fee schedule"}]}]},{"description":"NEUROSTIM PROG 1234X-1605","code_information":[{"code":"C1787","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":840,"maximum":4902,"gross_charge":6000,"discounted_cash":1374,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2271.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1703.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1703.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840,"methodology":"fee schedule"}]}]},{"description":"NEUROSTIM PROG 1605X-2087","code_information":[{"code":"C1787","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4402.71,"maximum":6786.82,"gross_charge":8307,"discounted_cash":1902.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4402.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6786.82,"methodology":"fee schedule"}]}]},{"description":"NEUROSTIM PROG 1605X-2087","code_information":[{"code":"C1787","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1162.98,"maximum":6786.82,"gross_charge":8307,"discounted_cash":1902.31,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2271.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1703.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1703.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4402.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6786.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.98,"methodology":"fee schedule"}]}]},{"description":"NEUROSTIM PROG 331X-431","code_information":[{"code":"C1787","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1211.58,"maximum":1867.67,"gross_charge":2286,"discounted_cash":523.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1211.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1867.67,"methodology":"fee schedule"}]}]},{"description":"NEUROSTIM PROG 331X-431","code_information":[{"code":"C1787","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":320.04,"maximum":2271.13,"gross_charge":2286,"discounted_cash":523.5,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2271.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1703.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1703.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1211.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1867.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.04,"methodology":"fee schedule"}]}]},{"description":"PORT INDWELL 254X-331","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"PORT INDWELL 254X-331","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":4248.65,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4248.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3187.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3187.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"PORT INDWELL 331X-431","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":815.67,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"}]}]},{"description":"PORT INDWELL 331X-431","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":215.46,"maximum":4248.65,"gross_charge":1539,"discounted_cash":352.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4248.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3187.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3187.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"}]}]},{"description":"PORT INDWELL 730X-949","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1797.76,"maximum":2771.27,"gross_charge":3392,"discounted_cash":776.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"}]}]},{"description":"PORT INDWELL 730X-949","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":474.88,"maximum":4248.65,"gross_charge":3392,"discounted_cash":776.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.37,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4248.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3187.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3187.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":736.07,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2771.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.88,"methodology":"fee schedule"}]}]},{"description":"PENILE INFLAT 10082X-11090","code_information":[{"code":"C1813","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":21686.97,"maximum":33430.66,"gross_charge":40918.8,"discounted_cash":9370.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21686.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33430.66,"methodology":"fee schedule"}]}]},{"description":"PENILE INFLAT 10082X-11090","code_information":[{"code":"C1813","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5728.64,"maximum":37107.26,"gross_charge":40918.8,"discounted_cash":9370.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6301.5,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6301.5,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37107.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27835.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27835.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8879.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8879.38,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21686.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33430.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5728.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5728.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5728.64,"methodology":"fee schedule"}]}]},{"description":"PENILE INFLAT 2087X-2714","code_information":[{"code":"C1813","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3180.53,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"}]}]},{"description":"PENILE INFLAT 2087X-2714","code_information":[{"code":"C1813","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":840.14,"maximum":37107.26,"gross_charge":6001,"discounted_cash":1374.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37107.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27835.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27835.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1302.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.14,"methodology":"fee schedule"}]}]},{"description":"PENILE INFLAT 3529X-4588","code_information":[{"code":"C1813","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5377.38,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"}]}]},{"description":"PENILE INFLAT 3529X-4588","code_information":[{"code":"C1813","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1420.44,"maximum":37107.26,"gross_charge":10146,"discounted_cash":2323.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.49,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1562.49,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37107.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27835.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27835.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2201.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2201.69,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"}]}]},{"description":"PENILE INFLAT 431X-561","code_information":[{"code":"C1813","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1062.12,"maximum":1637.27,"gross_charge":2004,"discounted_cash":458.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"}]}]},{"description":"PENILE INFLAT 431X-561","code_information":[{"code":"C1813","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":280.56,"maximum":37107.26,"gross_charge":2004,"discounted_cash":458.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37107.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":27835.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":27835.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":434.87,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1062.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.56,"methodology":"fee schedule"}]}]},{"description":"NEURSTM RECH 10082X-11090","code_information":[{"code":"C1820","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":22260,"maximum":34314,"gross_charge":42000,"discounted_cash":9618,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22260,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34314,"methodology":"fee schedule"}]}]},{"description":"NEURSTM RECH 10082X-11090","code_information":[{"code":"C1820","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5880,"maximum":66229.5,"gross_charge":42000,"discounted_cash":9618,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6468,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6468,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66229.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":49680.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":49680.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9114,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9114,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":22260,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34314,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5880,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5880,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5880,"methodology":"fee schedule"}]}]},{"description":"STENT COV W 2087X-2714","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":11021.35,"maximum":16989.52,"gross_charge":20795,"discounted_cash":4762.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11021.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16989.52,"methodology":"fee schedule"}]}]},{"description":"STENT COV W 2087X-2714","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2911.3,"maximum":16989.52,"gross_charge":20795,"discounted_cash":4762.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3202.43,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3202.43,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10920.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8192.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8192.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4512.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4512.52,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11021.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16989.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2911.3,"methodology":"fee schedule"}]}]},{"description":"STENT NCOV W 2087X-2714","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4558,"maximum":7026.2,"gross_charge":8600,"discounted_cash":1969.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4558,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7026.2,"methodology":"fee schedule"}]}]},{"description":"STENT NCOV W 2087X-2714","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1204,"maximum":7026.2,"gross_charge":8600,"discounted_cash":1969.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1324.4,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1324.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3954,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2966,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2966,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1866.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1866.2,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4558,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7026.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1204,"methodology":"fee schedule"}]}]},{"description":"STENT NCOV W 88X-115","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":231.08,"maximum":356.22,"gross_charge":436,"discounted_cash":99.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":231.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":356.22,"methodology":"fee schedule"}]}]},{"description":"STENT NCOV W 88X-115","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":61.04,"maximum":3954,"gross_charge":436,"discounted_cash":99.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.15,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.15,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3954,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2966,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2966,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":94.62,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":231.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":356.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.04,"methodology":"fee schedule"}]}]},{"description":"CATH GUIDING 67X-88","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":168.54,"maximum":259.81,"gross_charge":318,"discounted_cash":72.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":168.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":259.81,"methodology":"fee schedule"}]}]},{"description":"CATH GUIDING 67X-88","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":44.52,"maximum":271.75,"gross_charge":318,"discounted_cash":72.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.98,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.98,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":203.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":203.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":69.01,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":168.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":259.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"}]}]},{"description":"CATH STONE EXTRC 115X-150","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":283.55,"maximum":437.1,"gross_charge":535,"discounted_cash":122.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"}]}]},{"description":"CATH STONE EXTRC 115X-150","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":74.9,"maximum":1059.67,"gross_charge":535,"discounted_cash":122.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"}]}]},{"description":"CATH STONE EXTRC 254X-331","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"CATH STONE EXTRC 254X-331","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":165.48,"maximum":1059.67,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP <10","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2.65,"maximum":4.09,"gross_charge":5,"discounted_cash":1.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP <10","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.7,"maximum":1059.67,"gross_charge":5,"discounted_cash":1.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.09,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 150X-195","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 150X-195","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":97.58,"maximum":1059.67,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 23X-30","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":56.71,"maximum":87.42,"gross_charge":107,"discounted_cash":24.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.42,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 23X-30","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":14.98,"maximum":1059.67,"gross_charge":107,"discounted_cash":24.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":23.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 30X-39","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 30X-39","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":19.46,"maximum":1059.67,"gross_charge":139,"discounted_cash":31.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.41,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.17,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 3529X-4588","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5377.38,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 3529X-4588","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.49,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1562.49,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2201.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2201.69,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1420.44,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 51X-67","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.14,"maximum":194.45,"gross_charge":238,"discounted_cash":54.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 51X-67","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":33.32,"maximum":1059.67,"gross_charge":238,"discounted_cash":54.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.66,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.66,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":51.65,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 67X-88","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":125.08,"maximum":192.82,"gross_charge":236,"discounted_cash":54.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.82,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 67X-88","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":33.04,"maximum":1059.67,"gross_charge":236,"discounted_cash":54.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.35,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.35,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":51.22,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":125.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.04,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 88X-115","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":322.77,"maximum":497.56,"gross_charge":609,"discounted_cash":139.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"}]}]},{"description":"GASTRO IMP 88X-115","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":85.26,"maximum":1059.67,"gross_charge":609,"discounted_cash":139.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.79,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.79,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":132.16,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":322.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.26,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 1234X-1605","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3286,"maximum":5065.4,"gross_charge":6200,"discounted_cash":1419.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3286,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5065.4,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 1234X-1605","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":5065.4,"gross_charge":6200,"discounted_cash":1419.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":954.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":954.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1345.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1345.4,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3286,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5065.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":868,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":868,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":868,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 2714X-3529","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4136.12,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 2714X-3529","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1201.82,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1693.47,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.56,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 331X-431","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":815.67,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 331X-431","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":215.46,"maximum":1257.37,"gross_charge":1539,"discounted_cash":352.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.01,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":333.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":815.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.46,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 4588X-5965","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":12402,"maximum":19117.8,"gross_charge":23400,"discounted_cash":5358.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12402,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19117.8,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 4588X-5965","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":19117.8,"gross_charge":23400,"discounted_cash":5358.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3603.6,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3603.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5077.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5077.8,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12402,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19117.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3276,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3276,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3276,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 5965X-7755","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":13780,"maximum":21242,"gross_charge":26000,"discounted_cash":5954,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13780,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21242,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 5965X-7755","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":21242,"gross_charge":26000,"discounted_cash":5954,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4004,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5642,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5642,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":13780,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21242,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3640,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3640,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3640,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 730X-949","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1897.4,"maximum":2924.86,"gross_charge":3580,"discounted_cash":819.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1897.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2924.86,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 730X-949","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":501.2,"maximum":2924.86,"gross_charge":3580,"discounted_cash":819.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":551.32,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":551.32,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":776.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":776.86,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1897.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2924.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.2,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 88X-115","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":212,"maximum":326.8,"gross_charge":400,"discounted_cash":91.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":212,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":326.8,"methodology":"fee schedule"}]}]},{"description":"NON JOINT IMP 88X-115","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":56,"maximum":1059.67,"gross_charge":400,"discounted_cash":91.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.6,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.6,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":86.8,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":212,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":326.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"}]}]},{"description":"VASCULAR IMP 195X-254","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":480.71,"maximum":741.02,"gross_charge":907,"discounted_cash":207.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"}]}]},{"description":"VASCULAR IMP 195X-254","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":126.98,"maximum":1059.67,"gross_charge":907,"discounted_cash":207.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.68,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":196.82,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":480.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":741.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.98,"methodology":"fee schedule"}]}]},{"description":"VASCULAR IMP 2714X-3529","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":6678,"maximum":10294.2,"gross_charge":12600,"discounted_cash":2885.4,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6678,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10294.2,"methodology":"fee schedule"}]}]},{"description":"VASCULAR IMP 2714X-3529","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":10294.2,"gross_charge":12600,"discounted_cash":2885.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1940.4,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1940.4,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2734.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2734.2,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6678,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10294.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1764,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1764,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1764,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH <10","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":21.2,"maximum":32.68,"gross_charge":40,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH <10","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5.6,"maximum":147.91,"gross_charge":40,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.68,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 115X-150","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":253.87,"maximum":391.35,"gross_charge":479,"discounted_cash":109.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":253.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":391.35,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 115X-150","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":67.06,"maximum":391.35,"gross_charge":479,"discounted_cash":109.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.77,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.77,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.95,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":253.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":391.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.06,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 17X-23","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":42.93,"maximum":66.18,"gross_charge":81,"discounted_cash":18.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 17X-23","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":11.34,"maximum":147.91,"gross_charge":81,"discounted_cash":18.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.48,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.48,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.58,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 195X-254","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":527.88,"maximum":813.74,"gross_charge":996,"discounted_cash":228.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":527.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":813.74,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 195X-254","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":110.95,"maximum":813.74,"gross_charge":996,"discounted_cash":228.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":216.14,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":527.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":813.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.44,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 23X-30","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":51.94,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 23X-30","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":13.72,"maximum":147.91,"gross_charge":98,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.1,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.1,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":21.27,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 254X-331","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":626.46,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 254X-331","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":110.95,"maximum":965.7,"gross_charge":1182,"discounted_cash":270.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":256.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":626.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":965.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 30X-39","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":78.44,"maximum":120.92,"gross_charge":148,"discounted_cash":33.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 30X-39","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":20.72,"maximum":147.91,"gross_charge":148,"discounted_cash":33.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":32.12,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 39X-51","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":96.46,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 39X-51","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":25.48,"maximum":148.7,"gross_charge":182,"discounted_cash":41.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.03,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.5,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":96.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 51X-67","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":218.89,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 51X-67","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.82,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.61,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.61,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":89.63,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 67X-88","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":144.69,"maximum":223.05,"gross_charge":273,"discounted_cash":62.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.05,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 67X-88","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":38.22,"maximum":223.05,"gross_charge":273,"discounted_cash":62.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.05,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.05,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":59.25,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":144.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":223.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 88X-115","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":217.3,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"}]}]},{"description":"INTRO SHTH OTH 88X-115","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.4,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":110.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"}]}]},{"description":"NEURST TST LEAD 115X-150","code_information":[{"code":"C1897","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":252.28,"maximum":388.9,"gross_charge":476,"discounted_cash":109.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":252.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":388.9,"methodology":"fee schedule"}]}]},{"description":"NEURST TST LEAD 115X-150","code_information":[{"code":"C1897","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":66.64,"maximum":1560.2,"gross_charge":476,"discounted_cash":109.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.31,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.31,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1560.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1170.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1170.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":103.3,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":252.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":388.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.64,"methodology":"fee schedule"}]}]},{"description":"NEURST TST LEAD 30X-39","code_information":[{"code":"C1897","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"NEURST TST LEAD 30X-39","code_information":[{"code":"C1897","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":21.7,"maximum":1560.2,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.87,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1560.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1170.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1170.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":33.64,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.7,"methodology":"fee schedule"}]}]},{"description":"NEURST TST LEAD 39X-51","code_information":[{"code":"C1897","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":108.12,"maximum":166.67,"gross_charge":204,"discounted_cash":46.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"}]}]},{"description":"NEURST TST LEAD 39X-51","code_information":[{"code":"C1897","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":28.56,"maximum":1560.2,"gross_charge":204,"discounted_cash":46.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.42,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.42,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1560.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1170.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1170.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":44.27,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":108.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.56,"methodology":"fee schedule"}]}]},{"description":"NEURST TST LEAD 67X-88","code_information":[{"code":"C1897","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":164.3,"maximum":253.27,"gross_charge":310,"discounted_cash":70.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":164.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":253.27,"methodology":"fee schedule"}]}]},{"description":"NEURST TST LEAD 67X-88","code_information":[{"code":"C1897","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":43.4,"maximum":1560.2,"gross_charge":310,"discounted_cash":70.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.74,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.74,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1560.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1170.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1170.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":67.27,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":164.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":253.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 150X-195","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":326.48,"maximum":503.28,"gross_charge":616,"discounted_cash":141.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":326.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":503.28,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 150X-195","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":86.24,"maximum":503.28,"gross_charge":616,"discounted_cash":141.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.87,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.87,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":245.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":133.68,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":326.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":503.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.24,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 2714X-3529","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":6360,"maximum":9804,"gross_charge":12000,"discounted_cash":2748,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6360,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9804,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 2714X-3529","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":184.18,"maximum":9804,"gross_charge":12000,"discounted_cash":2748,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1848,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1848,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":245.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2604,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2604,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6360,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9804,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1680,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1680,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1680,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 51X-67","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":270.83,"maximum":417.49,"gross_charge":511,"discounted_cash":117.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":270.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":417.49,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 51X-67","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":71.54,"maximum":417.49,"gross_charge":511,"discounted_cash":117.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.7,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.7,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":245.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":110.89,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":270.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":417.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.54,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 67X-88","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":356.16,"maximum":549.03,"gross_charge":672,"discounted_cash":153.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":356.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":549.03,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 67X-88","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":94.08,"maximum":549.03,"gross_charge":672,"discounted_cash":153.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.49,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.49,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":245.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":145.83,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":356.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":549.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.08,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 88X-115","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":217.3,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR WO 88X-115","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.4,"maximum":334.97,"gross_charge":410,"discounted_cash":93.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":245.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":184.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":217.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR W 115X-150","code_information":[{"code":"C2625","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":283.55,"maximum":437.1,"gross_charge":535,"discounted_cash":122.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR W 115X-150","code_information":[{"code":"C2625","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":74.9,"maximum":799.97,"gross_charge":535,"discounted_cash":122.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":799.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":116.1,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR W 150X-195","code_information":[{"code":"C2625","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":369.41,"maximum":569.45,"gross_charge":697,"discounted_cash":159.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"}]}]},{"description":"STENT NONCOR W 150X-195","code_information":[{"code":"C2625","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":97.58,"maximum":799.97,"gross_charge":697,"discounted_cash":159.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.34,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":799.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":600.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":151.25,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":369.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.58,"methodology":"fee schedule"}]}]},{"description":"CATH SUPRAPUBIC 115X-150","code_information":[{"code":"C2627","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":295.21,"maximum":455.07,"gross_charge":557,"discounted_cash":127.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":295.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":455.07,"methodology":"fee schedule"}]}]},{"description":"CATH SUPRAPUBIC 115X-150","code_information":[{"code":"C2627","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":77.98,"maximum":455.07,"gross_charge":557,"discounted_cash":127.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.78,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.78,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":133.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":133.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":120.87,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":295.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":455.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.98,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO ABDOMEN W CONTRAST","code_information":[{"code":"C8900","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":2001.28,"maximum":3085,"gross_charge":3776,"discounted_cash":864.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2001.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3085,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO ABDOMEN W CONTRAST","code_information":[{"code":"C8900","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":240.06,"maximum":3085,"gross_charge":3776,"discounted_cash":864.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":240.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":240.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2001.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3085,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO ABDOMEN WO CONTRAST","code_information":[{"code":"C8901","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":1471.28,"maximum":2268,"gross_charge":2776,"discounted_cash":635.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1471.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2268,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO ABDOMEN WO CONTRAST","code_information":[{"code":"C8901","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":171.01,"maximum":2268,"gross_charge":2776,"discounted_cash":635.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":240.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":240.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1471.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2268,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO CHEST W CONTRAST","code_information":[{"code":"C8909","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":2147.03,"maximum":3309.67,"gross_charge":4051,"discounted_cash":927.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2147.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3309.67,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO CHEST W CONTRAST","code_information":[{"code":"C8909","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":240.33,"maximum":3309.67,"gross_charge":4051,"discounted_cash":927.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":240.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":240.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2147.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3309.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO CHEST WO CONTRAST","code_information":[{"code":"C8910","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":1087.03,"maximum":1675.67,"gross_charge":2051,"discounted_cash":469.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1087.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1675.67,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO CHEST WO CONTRAST","code_information":[{"code":"C8910","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":171.01,"maximum":1698,"gross_charge":2051,"discounted_cash":469.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":240.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":240.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1087.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1675.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO CHEST WO AND W CON","code_information":[{"code":"C8911","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":3207.03,"maximum":4943.67,"gross_charge":6051,"discounted_cash":1385.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3207.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4943.67,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO CHEST WO AND W CON","code_information":[{"code":"C8911","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":240.33,"maximum":4943.67,"gross_charge":6051,"discounted_cash":1385.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":240.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":240.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3207.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4943.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO LOWER EXTR W CONTRAST","code_information":[{"code":"C8912","type":"HCPCS"},{"code":"0616","type":"RC"}],"standard_charges":[{"minimum":1959.41,"maximum":3020.45,"gross_charge":3697,"discounted_cash":846.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1959.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3020.45,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO LOWER EXTR W CONTRAST","code_information":[{"code":"C8912","type":"HCPCS"},{"code":"0616","type":"RC"}],"standard_charges":[{"minimum":241.99,"maximum":3020.45,"gross_charge":3697,"discounted_cash":846.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1617,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1959.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3020.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO LOWER EXTR WO CON","code_information":[{"code":"C8913","type":"HCPCS"},{"code":"0616","type":"RC"}],"standard_charges":[{"minimum":1959.41,"maximum":3020.45,"gross_charge":3697,"discounted_cash":846.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1959.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3020.45,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO LOWER EXTR WO CON","code_information":[{"code":"C8913","type":"HCPCS"},{"code":"0616","type":"RC"}],"standard_charges":[{"minimum":171.01,"maximum":3020.45,"gross_charge":3697,"discounted_cash":846.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1959.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3020.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO LOWER EXTR WO AND CON","code_information":[{"code":"C8914","type":"HCPCS"},{"code":"0616","type":"RC"}],"standard_charges":[{"minimum":2489.41,"maximum":3837.45,"gross_charge":4697,"discounted_cash":1075.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2489.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3837.45,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO LOWER EXTR WO AND CON","code_information":[{"code":"C8914","type":"HCPCS"},{"code":"0616","type":"RC"}],"standard_charges":[{"minimum":241.99,"maximum":3837.45,"gross_charge":4697,"discounted_cash":1075.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2489.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3837.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO PELVIS W CONTRAST","code_information":[{"code":"C8918","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":2101.98,"maximum":3240.23,"gross_charge":3966,"discounted_cash":908.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2101.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3240.23,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO PELVIS W CONTRAST","code_information":[{"code":"C8918","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":233.95,"maximum":3240.23,"gross_charge":3966,"discounted_cash":908.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":233.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":233.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2101.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3240.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO PELVIS WO CONTRAST","code_information":[{"code":"C8919","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":1571.98,"maximum":2423.23,"gross_charge":2966,"discounted_cash":679.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1571.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2423.23,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO PELVIS WO CONTRAST","code_information":[{"code":"C8919","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":171.01,"maximum":2423.23,"gross_charge":2966,"discounted_cash":679.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":233.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":233.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1571.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2423.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO PELVIS WO AND W CON","code_information":[{"code":"C8920","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":2631.98,"maximum":4057.23,"gross_charge":4966,"discounted_cash":1137.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2631.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4057.23,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO PELVIS WO AND W CON","code_information":[{"code":"C8920","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":233.95,"maximum":4057.23,"gross_charge":4966,"discounted_cash":1137.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":233.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":233.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2631.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4057.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"ECHO 2D COMP W CON","code_information":[{"code":"C8923","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1678.51,"maximum":2587.44,"gross_charge":3167,"discounted_cash":725.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1678.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2587.44,"methodology":"fee schedule"}]}]},{"description":"ECHO 2D COMP W CON","code_information":[{"code":"C8923","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":511.24,"maximum":2587.44,"gross_charge":3167,"discounted_cash":725.25,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":511.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":511.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1678.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2587.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"ECHO 2D LMTD W CON","code_information":[{"code":"C8924","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":811.96,"maximum":1251.65,"gross_charge":1532,"discounted_cash":350.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":811.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1251.65,"methodology":"fee schedule"}]}]},{"description":"ECHO 2D LMTD W CON","code_information":[{"code":"C8924","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":273.56,"maximum":1251.65,"gross_charge":1532,"discounted_cash":350.83,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":332.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":332.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":811.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1251.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"ECHO STR TEST COMP W CON","code_information":[{"code":"C8928","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1092.33,"maximum":1683.84,"gross_charge":2061,"discounted_cash":471.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1092.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1683.84,"methodology":"fee schedule"}]}]},{"description":"ECHO STR TEST COMP W CON","code_information":[{"code":"C8928","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":531.47,"maximum":3153.82,"gross_charge":2061,"discounted_cash":471.97,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3153.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2365.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2365.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1092.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1683.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"TTE COMP W SPEC/CF W CON","code_information":[{"code":"C8929","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1785.57,"maximum":2752.48,"gross_charge":3369,"discounted_cash":771.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1785.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2752.48,"methodology":"fee schedule"}]}]},{"description":"TTE COMP W SPEC/CF W CON","code_information":[{"code":"C8929","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":531.47,"maximum":2752.48,"gross_charge":3369,"discounted_cash":771.51,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2224.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1668.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1668.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1785.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2752.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":850.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":858.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":863.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":842.06,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO UPPER EXTR W CONTRAST","code_information":[{"code":"C8934","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":1479.23,"maximum":2280.25,"gross_charge":2791,"discounted_cash":639.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1479.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2280.25,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO UPPER EXTR W CONTRAST","code_information":[{"code":"C8934","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":252.97,"maximum":2280.25,"gross_charge":2791,"discounted_cash":639.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":252.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":252.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1479.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2280.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO UPPER EXTR WO CONTRAST","code_information":[{"code":"C8935","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":949.23,"maximum":1463.25,"gross_charge":1791,"discounted_cash":410.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":949.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1463.25,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO UPPER EXTR WO CONTRAST","code_information":[{"code":"C8935","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":171.01,"maximum":1698,"gross_charge":1791,"discounted_cash":410.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":252.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":252.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":949.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1463.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":525.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":260.21,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":262.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":264.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":257.63,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO UPPER EXTR WO W CON","code_information":[{"code":"C8936","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":2009.23,"maximum":3097.25,"gross_charge":3791,"discounted_cash":868.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2009.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3097.25,"methodology":"fee schedule"}]}]},{"description":"MR ANGIO UPPER EXTR WO W CON","code_information":[{"code":"C8936","type":"HCPCS"},{"code":"0618","type":"RC"}],"standard_charges":[{"minimum":252.97,"maximum":3097.25,"gross_charge":3791,"discounted_cash":868.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":252.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":252.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2009.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3097.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":824.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":384.45,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":392.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":388.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":390.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":380.64,"methodology":"fee schedule"}]}]},{"description":"NRV GUIDE 3CM 1605X-2087","code_information":[{"code":"C9352","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3952.74,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"}]}]},{"description":"NRV GUIDE 3CM 1605X-2087","code_information":[{"code":"C9352","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1032.94,"maximum":6093.19,"gross_charge":7458,"discounted_cash":1707.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1148.54,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4973.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3731.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3731.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1852.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1852.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6093.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.94,"methodology":"fee schedule"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9600","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9601","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9602","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9603","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9604","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9605","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9606","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9607","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"PTCA WITH DRUG ELUTING STENT","code_information":[{"code":"C9608","type":"CPT"}],"standard_charges":[{"minimum":74582,"maximum":95959,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total 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":94442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":74582,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95959,"methodology":"case rate"}]}]},{"description":"ADMIN INFLUENZA VACCINE","code_information":[{"code":"G0008","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"}]}]},{"description":"ADMIN INFLUENZA VACCINE","code_information":[{"code":"G0008","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":7.57,"maximum":163.4,"gross_charge":200,"discounted_cash":45.8,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":50.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"}]}]},{"description":"ADMIN PNEUMO VACCINE","code_information":[{"code":"G0009","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":51.94,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"}]}]},{"description":"ADMIN PNEUMO VACCINE","code_information":[{"code":"G0009","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":7.57,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":50.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"}]}]},{"description":"ADMIN HEP B VACCINE","code_information":[{"code":"G0010","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":32.86,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"}]}]},{"description":"ADMIN HEP B VACCINE","code_information":[{"code":"G0010","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":7.57,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":49.68,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":50.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":49.18,"methodology":"fee schedule"}]}]},{"description":"PSA PROSTATE CANCER SCREENING","code_information":[{"code":"G0103","type":"HCPCS"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":134.62,"maximum":207.52,"gross_charge":254,"discounted_cash":58.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":207.52,"methodology":"fee schedule"}]}]},{"description":"PSA PROSTATE CANCER SCREENING","code_information":[{"code":"G0103","type":"HCPCS"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":11.59,"maximum":207.52,"gross_charge":254,"discounted_cash":58.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":45.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":45.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":207.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":19.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":19.89,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"}]}]},{"description":"DIALYSIS OP ESRD EMER","code_information":[{"code":"G0257","type":"HCPCS"},{"code":"0829","type":"RC"}],"standard_charges":[{"minimum":1429.94,"maximum":2204.27,"gross_charge":2698,"discounted_cash":617.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1429.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2204.27,"methodology":"fee schedule"}]}]},{"description":"DIALYSIS OP ESRD EMER","code_information":[{"code":"G0257","type":"HCPCS"},{"code":"0829","type":"RC"}],"standard_charges":[{"minimum":235.78,"maximum":2204.27,"gross_charge":2698,"discounted_cash":617.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":990.17,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":990.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2083,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1562.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1562.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1429.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2204.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":753.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":768.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":760.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":764.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"}]}]},{"description":"EMERGENCY ESRD DIALYSIS TRMT","code_information":[{"code":"G0257","type":"HCPCS"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1272.53,"maximum":1961.62,"gross_charge":2401,"discounted_cash":549.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1272.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1961.62,"methodology":"fee schedule"}]}]},{"description":"EMERGENCY ESRD DIALYSIS TRMT","code_information":[{"code":"G0257","type":"HCPCS"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":235.78,"maximum":2083,"gross_charge":2401,"discounted_cash":549.83,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2083,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1562.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1562.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1272.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1961.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":753.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":768.16,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":760.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":764.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":745.78,"methodology":"fee schedule"}]}]},{"description":"HBOT FULL BODY CHAMBER 30M","code_information":[{"code":"G0277","type":"HCPCS"}],"standard_charges":[{"minimum":1199,"maximum":1199,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1199,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1199,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OBSERVATION PER HOUR","code_information":[{"code":"G0378","type":"HCPCS"},{"code":"0762","type":"RC"}],"standard_charges":[{"minimum":69.96,"maximum":107.85,"gross_charge":132,"discounted_cash":30.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"}]}]},{"description":"OBSERVATION PER HOUR","code_information":[{"code":"G0378","type":"HCPCS"},{"code":"0762","type":"RC"}],"standard_charges":[{"minimum":30.75,"maximum":115.65,"gross_charge":132,"discounted_cash":30.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.69,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.69,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":86.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":86.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":50.03,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"}]}]},{"description":"DIRECT ADMISSION FOR OBSV","code_information":[{"code":"G0379","type":"HCPCS"},{"code":"0762","type":"RC"}],"standard_charges":[{"minimum":1206.28,"maximum":1859.5,"gross_charge":2276,"discounted_cash":521.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1206.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1859.5,"methodology":"fee schedule"}]}]},{"description":"DIRECT ADMISSION FOR OBSV","code_information":[{"code":"G0379","type":"HCPCS"},{"code":"0762","type":"RC"}],"standard_charges":[{"minimum":30.75,"maximum":1859.5,"gross_charge":2276,"discounted_cash":521.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":994.62,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":994.62,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":98.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":98.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":862.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":862.61,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1206.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1859.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":659.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":673.06,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":666.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":669.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":653.45,"methodology":"fee schedule"}]}]},{"description":"ALCOH/SUBST INTERV 15-30","code_information":[{"code":"G0396","type":"HCPCS"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"ALCOH/SUBST INTERV 15-30","code_information":[{"code":"G0396","type":"HCPCS"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":31.75,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":32.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":32.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"}]}]},{"description":"ALCOH/SUBST INTERV >30MN","code_information":[{"code":"G0397","type":"HCPCS"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":113.57,"gross_charge":139,"discounted_cash":31.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"ALCOH/SUBST INTERV >30MN","code_information":[{"code":"G0397","type":"HCPCS"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":73.67,"maximum":143.17,"gross_charge":139,"discounted_cash":31.84,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":140.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":143.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":141.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":142.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"}]}]},{"description":"HOME SLEEP TEST/TYPE II PORT","code_information":[{"code":"G0398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HOME SLEEP TEST/TYPE III POR","code_information":[{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HOME SLEEP TEST/TYPE IV PORT","code_information":[{"code":"G0400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":39.3,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PLACE PERM PACING CARDIOVERT","code_information":[{"code":"G0448","type":"HCPCS"}],"standard_charges":[{"minimum":9048,"maximum":9048,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9048,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE DRAINAGE CATH/TUBE","code_information":[{"code":"G0463","type":"HCPCS"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":157.41,"maximum":242.65,"gross_charge":297,"discounted_cash":68.02,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.65,"methodology":"fee schedule"}]}]},{"description":"REMOVE DRAINAGE CATH/TUBE","code_information":[{"code":"G0463","type":"HCPCS"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":137.35,"maximum":339.49,"gross_charge":297,"discounted_cash":68.02,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":339.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":254.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":254.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":157.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":137.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":138.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":141.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":140.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":137.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":137.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":137.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":140.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":137.35,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 1 OR 2","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":148.4,"maximum":228.76,"gross_charge":280,"discounted_cash":64.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":148.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":228.76,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 1 OR 2","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":280,"discounted_cash":64.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":148.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":228.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACETAZOLAMIDE QN SP 91366","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.12,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"}]}]},{"description":"RL-A-ACETAZOLAMIDE QN SP 91366","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.12,"maximum":556.89,"gross_charge":104,"discounted_cash":23.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":105.04,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":107.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":106.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":106.6,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMITRIPT NORTRIP SP 90158","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":117.66,"maximum":181.38,"gross_charge":222,"discounted_cash":50.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMITRIPT NORTRIP SP 90158","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":222,"discounted_cash":50.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":117.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMP SERM PLASM QN 2010066","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":242.74,"maximum":374.19,"gross_charge":458,"discounted_cash":104.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":242.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":374.19,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMP SERM PLASM QN 2010066","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":458,"discounted_cash":104.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":242.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":374.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMPS UR QUANT 2010075","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.51,"maximum":54.74,"gross_charge":67,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-AMPS UR QUANT 2010075","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.51,"maximum":556.89,"gross_charge":67,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":69.01,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":68.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":68.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-BARBITURATE UR QN 2012213","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":112.36,"maximum":173.21,"gross_charge":212,"discounted_cash":48.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":173.21,"methodology":"fee schedule"}]}]},{"description":"RL-A-BARBITURATE UR QN 2012213","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":212,"discounted_cash":48.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":112.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":173.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-BENZODIAZEP UR QN 2008291","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.36,"maximum":91.51,"gross_charge":112,"discounted_cash":25.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"}]}]},{"description":"RL-A-BENZODIAZEP UR QN 2008291","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.36,"maximum":556.89,"gross_charge":112,"discounted_cash":25.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":112,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":113.12,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":114.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":112,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":112,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":112,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":112,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARIS MEPRO UR QN 2012219","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":121.37,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-CARIS MEPRO UR QN 2012219","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":229,"discounted_cash":52.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHLORPROMAZINE SP 3003036","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":137.8,"maximum":212.42,"gross_charge":260,"discounted_cash":59.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"}]}]},{"description":"RL-A-CHLORPROMAZINE SP 3003036","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":260,"discounted_cash":59.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-CLOMIPRAMINE SP 99336","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":81.62,"maximum":125.82,"gross_charge":154,"discounted_cash":35.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"}]}]},{"description":"RL-A-CLOMIPRAMINE SP 99336","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":154,"discounted_cash":35.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-CLONAZEPAM 90055","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":60.42,"maximum":93.14,"gross_charge":114,"discounted_cash":26.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"}]}]},{"description":"RL-A-CLONAZEPAM 90055","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":60.42,"maximum":556.89,"gross_charge":114,"discounted_cash":26.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.42,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":116.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114,"methodology":"fee schedule"}]}]},{"description":"RL-A-CLORAZEPATE 90196","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"RL-A-CLORAZEPATE 90196","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":43.46,"maximum":556.89,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":82.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":83.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":84.05,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCAINE UR QN 90359","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":47.17,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"}]}]},{"description":"RL-A-COCAINE UR QN 90359","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":47.17,"maximum":556.89,"gross_charge":89,"discounted_cash":20.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":89.89,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":91.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":90.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":89,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":91.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":89,"methodology":"fee schedule"}]}]},{"description":"RL-A-DIAZEPAM NORDIAZEPA 90076","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":179.14,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"}]}]},{"description":"RL-A-DIAZEPAM NORDIAZEPA 90076","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":338,"discounted_cash":77.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-DIGITOXIN QN SP 3002537","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":192.92,"maximum":297.39,"gross_charge":364,"discounted_cash":83.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":192.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":297.39,"methodology":"fee schedule"}]}]},{"description":"RL-A-DIGITOXIN QN SP 3002537","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":364,"discounted_cash":83.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":192.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":297.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-DOA CONF/QN THC MEC 92316","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":45.58,"maximum":70.27,"gross_charge":86,"discounted_cash":19.7,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"}]}]},{"description":"RL-A-DOA CONF/QN THC MEC 92316","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":45.58,"maximum":556.89,"gross_charge":86,"discounted_cash":19.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":86.86,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":88.58,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":87.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":88.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":86,"methodology":"fee schedule"}]}]},{"description":"RL-A-DOXEPIN METAB SP 90102","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.41,"maximum":79.25,"gross_charge":97,"discounted_cash":22.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-DOXEPIN METAB SP 90102","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":51.41,"maximum":556.89,"gross_charge":97,"discounted_cash":22.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":99.91,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":98.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":97,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":99.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":97,"methodology":"fee schedule"}]}]},{"description":"RL-A-FENTANYL UR QUANT 92570","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":60.95,"maximum":93.96,"gross_charge":115,"discounted_cash":26.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-FENTANYL UR QUANT 92570","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":60.95,"maximum":556.89,"gross_charge":115,"discounted_cash":26.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-FLUPHENAZINE 99906","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":130.91,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"}]}]},{"description":"RL-A-FLUPHENAZINE 99906","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":247,"discounted_cash":56.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-HYPOGLY SER PLASM 3005636","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":271.36,"maximum":418.31,"gross_charge":512,"discounted_cash":117.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":271.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":418.31,"methodology":"fee schedule"}]}]},{"description":"RL-A-HYPOGLY SER PLASM 3005636","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":512,"discounted_cash":117.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":271.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":418.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMIPRAMINE DESIP SP 90157","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":45.05,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"}]}]},{"description":"RL-A-IMIPRAMINE DESIP SP 90157","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":45.05,"maximum":556.89,"gross_charge":85,"discounted_cash":19.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":85.85,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":87.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":86.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":87.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":85,"methodology":"fee schedule"}]}]},{"description":"RL-A-ISOPROPANOL 90144","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":53,"maximum":81.7,"gross_charge":100,"discounted_cash":22.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.7,"methodology":"fee schedule"}]}]},{"description":"RL-A-ISOPROPANOL 90144","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":53,"maximum":556.89,"gross_charge":100,"discounted_cash":22.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":103,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":102,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":102.5,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"}]}]},{"description":"RL-A-LORAZEPAM 90181","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"RL-A-LORAZEPAM 90181","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.23,"maximum":556.89,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":91.91,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":93.73,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":92.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":91,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHADONE SP QN 90699","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":53.53,"maximum":82.52,"gross_charge":101,"discounted_cash":23.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHADONE SP QN 90699","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":53.53,"maximum":556.89,"gross_charge":101,"discounted_cash":23.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":102.01,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":104.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":103.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":103.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":101,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHADONE UR QN 90362","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.88,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHADONE UR QN 90362","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.88,"maximum":556.89,"gross_charge":96,"discounted_cash":21.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":96.96,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":98.88,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":97.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":98.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":96,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHANOL 90165","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.66,"maximum":99.68,"gross_charge":122,"discounted_cash":27.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"}]}]},{"description":"RL-A-METHANOL 90165","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.66,"maximum":556.89,"gross_charge":122,"discounted_cash":27.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-NICOTINE UR QUANT 92356","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.45,"maximum":134.81,"gross_charge":165,"discounted_cash":37.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":134.81,"methodology":"fee schedule"}]}]},{"description":"RL-A-NICOTINE UR QUANT 92356","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":165,"discounted_cash":37.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":87.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":134.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-NORTRIPTYLINE 90074","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":45.76,"gross_charge":56,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"}]}]},{"description":"RL-A-NORTRIPTYLINE 90074","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.68,"maximum":556.89,"gross_charge":56,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":56.56,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":57.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":57.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"}]}]},{"description":"RL-A-OPIATES URINE QUANT 90364","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"RL-A-OPIATES URINE QUANT 90364","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":556.89,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":92.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":93.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":94.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"}]}]},{"description":"RL-A-PCP URINE QUANT 2010462","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":104.94,"maximum":161.77,"gross_charge":198,"discounted_cash":45.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"}]}]},{"description":"RL-A-PCP URINE QUANT 2010462","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":198,"discounted_cash":45.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":104.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-PETH WHOLE BLD QN 3002598","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":257.05,"maximum":396.25,"gross_charge":485,"discounted_cash":111.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":257.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":396.25,"methodology":"fee schedule"}]}]},{"description":"RL-A-PETH WHOLE BLD QN 3002598","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":485,"discounted_cash":111.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":257.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":396.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTRIPTYLINE SP 90106","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.69,"maximum":59.65,"gross_charge":73,"discounted_cash":16.72,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"}]}]},{"description":"RL-A-PROTRIPTYLINE SP 90106","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.69,"maximum":556.89,"gross_charge":73,"discounted_cash":16.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":73.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":75.19,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":74.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":74.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":73,"methodology":"fee schedule"}]}]},{"description":"RL-A-RF TRAMODOL UR QN 2002736","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":77.91,"maximum":120.1,"gross_charge":147,"discounted_cash":33.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.1,"methodology":"fee schedule"}]}]},{"description":"RL-A-RF TRAMODOL UR QN 2002736","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":147,"discounted_cash":33.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":77.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BUPR UR QN 2010092","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX BUPR UR QN 2010092","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":556.89,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":80,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":80.8,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":82.4,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":81.6,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":80,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":80,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX CDCO ETG/S 2007909","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":74.2,"maximum":114.38,"gross_charge":140,"discounted_cash":32.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.38,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX CDCO ETG/S 2007909","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":140,"discounted_cash":32.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":74.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX OPIATES SP QN 92354","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":242.6,"maximum":373.96,"gross_charge":457.72,"discounted_cash":104.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":242.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.96,"methodology":"fee schedule"}]}]},{"description":"RL-A-RFLX OPIATES SP QN 92354","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":457.72,"discounted_cash":104.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":242.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-SULFONAMIDE QN AP 3001973","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.61,"maximum":30.23,"gross_charge":37,"discounted_cash":8.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"}]}]},{"description":"RL-A-SULFONAMIDE QN AP 3001973","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.61,"maximum":556.89,"gross_charge":37,"discounted_cash":8.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":37.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"}]}]},{"description":"RL-A-TAPENTADOL UR QN 2003128","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":118.72,"maximum":183.01,"gross_charge":224,"discounted_cash":51.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"}]}]},{"description":"RL-A-TAPENTADOL UR QN 2003128","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":224,"discounted_cash":51.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-THC METABOL SP QN 90676","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.65,"maximum":85.79,"gross_charge":105,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"}]}]},{"description":"RL-A-THC METABOL SP QN 90676","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.65,"maximum":556.89,"gross_charge":105,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":106.05,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":108.15,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":107.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRAZODON SRM/PLAS 3005860","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":63.6,"maximum":98.04,"gross_charge":120,"discounted_cash":27.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"}]}]},{"description":"RL-A-TRAZODON SRM/PLAS 3005860","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":63.6,"maximum":556.89,"gross_charge":120,"discounted_cash":27.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZOLPIDEM URINE QN 2012319","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":83.74,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"}]}]},{"description":"RL-A-ZOLPIDEM URINE QN 2012319","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.66,"maximum":556.89,"gross_charge":158,"discounted_cash":36.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":115.58,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"}]}]},{"description":"RL-A-DRUG DET MEC QUAL 3004583","code_information":[{"code":"G0482","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.37,"maximum":105.4,"gross_charge":129,"discounted_cash":29.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"}]}]},{"description":"RL-A-DRUG DET MEC QUAL 3004583","code_information":[{"code":"G0482","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.37,"maximum":967.2,"gross_charge":129,"discounted_cash":29.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":967.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":967.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":549.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":119.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":119.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":130.29,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":132.87,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":131.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":132.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"}]}]},{"description":"RL-A-DRUG DET UMBIL QL 2006621","code_information":[{"code":"G0482","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":137.27,"maximum":211.61,"gross_charge":259,"discounted_cash":59.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"}]}]},{"description":"RL-A-DRUG DET UMBIL QL 2006621","code_information":[{"code":"G0482","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":119.24,"maximum":967.2,"gross_charge":259,"discounted_cash":59.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":967.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":967.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":549.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":211.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":119.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":119.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":200.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":204.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":202.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":198.74,"methodology":"fee schedule"}]}]},{"description":"RL-A-DRUG PROF SER PLA 3004833","code_information":[{"code":"G0483","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":421.35,"maximum":649.52,"gross_charge":795,"discounted_cash":182.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":421.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":649.52,"methodology":"fee schedule"}]}]},{"description":"RL-A-DRUG PROF SER PLA 3004833","code_information":[{"code":"G0483","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":148.15,"maximum":1201.73,"gross_charge":795,"discounted_cash":182.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1201.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":682.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":512.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":512.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":421.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":649.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":148.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":148.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":249.39,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":254.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":251.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":253.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":246.92,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEIN 200MG/ML 30ML IN","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66220-0207-30","type":"NDC"}],"standard_charges":[{"minimum":881.39,"maximum":1358.68,"gross_charge":1663,"discounted_cash":380.83,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":881.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358.68,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEIN 200MG/ML 30ML IN","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66220-0207-30","type":"NDC"}],"standard_charges":[{"minimum":0.56,"maximum":1358.68,"gross_charge":1663,"discounted_cash":380.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":881.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR 50MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0325-10","type":"NDC"}],"standard_charges":[{"minimum":81.09,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR 50MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0325-10","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0318-02","type":"NDC"}],"standard_charges":[{"minimum":32.86,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0318-02","type":"NDC"}],"standard_charges":[{"minimum":0.33,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRIN PF 0.1MG/ML 10MLINJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3316-01","type":"NDC"}],"standard_charges":[{"minimum":53.53,"maximum":82.52,"gross_charge":101,"discounted_cash":23.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.52,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRIN PF 0.1MG/ML 10MLINJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3316-01","type":"NDC"}],"standard_charges":[{"minimum":0.78,"maximum":82.52,"gross_charge":101,"discounted_cash":23.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1MG(30MG)MDV","drug_information": {"unit": 0.1,"type": "ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-3030-01","type":"NDC"}],"standard_charges":[{"minimum":3.71,"maximum":5.72,"gross_charge":7,"discounted_cash":1.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1MG(30MG)MDV","drug_information": {"unit": 0.1,"type": "ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-3030-01","type":"NDC"}],"standard_charges":[{"minimum":0.78,"maximum":5.72,"gross_charge":7,"discounted_cash":1.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0159-25","type":"NDC"}],"standard_charges":[{"minimum":81.09,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0159-25","type":"NDC"}],"standard_charges":[{"minimum":0.78,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"}]}]},{"description":"REMDESIVIR 100MG LYPH INJJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61958-2901-02","type":"NDC"}],"standard_charges":[{"minimum":2342.6,"maximum":3611.14,"gross_charge":4420,"discounted_cash":1012.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2342.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3611.14,"methodology":"fee schedule"}]}]},{"description":"REMDESIVIR 100MG LYPH INJJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61958-2901-02","type":"NDC"}],"standard_charges":[{"minimum":11.38,"maximum":3611.14,"gross_charge":4420,"discounted_cash":1012.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2342.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3611.14,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 250MG/ML 4ML INJ","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0173-04","type":"NDC"}],"standard_charges":[{"minimum":84.27,"maximum":129.91,"gross_charge":159,"discounted_cash":36.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.91,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 250MG/ML 4ML INJ","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0173-04","type":"NDC"}],"standard_charges":[{"minimum":0.55,"maximum":129.91,"gross_charge":159,"discounted_cash":36.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":84.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"}]}]},{"description":"AMINOPHYLLINE 25MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J0280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-5922-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"AMINOPHYLLINE 25MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J0280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-5922-01","type":"NDC"}],"standard_charges":[{"minimum":5.3,"maximum":47.56,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 450MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61553-0721-11","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 450MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61553-0721-11","type":"NDC"}],"standard_charges":[{"minimum":0.4,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50MG/ML 3ML INJ","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0616-03","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50MG/ML 3ML INJ","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0616-03","type":"NDC"}],"standard_charges":[{"minimum":0.4,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"AMIODA(NEX)150MG/100MLPMX","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J0283","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0150-10","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"AMIODA(NEX)150MG/100MLPMX","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J0283","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0150-10","type":"NDC"}],"standard_charges":[{"minimum":4.57,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"AMPHO B LIPO LYOPH 50MG SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0289","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00469-3051-30","type":"NDC"}],"standard_charges":[{"minimum":1336.13,"maximum":2059.66,"gross_charge":2521,"discounted_cash":577.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1336.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2059.66,"methodology":"fee schedule"}]}]},{"description":"AMPHO B LIPO LYOPH 50MG SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0289","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00469-3051-30","type":"NDC"}],"standard_charges":[{"minimum":21.86,"maximum":2059.66,"gross_charge":2521,"discounted_cash":577.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":75.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":75.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1336.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2059.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":24.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":24.35,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":24.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":24.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":24.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":24.1,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00015-7404-99","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00015-7404-99","type":"NDC"}],"standard_charges":[{"minimum":0.73,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00015-7405-99","type":"NDC"}],"standard_charges":[{"minimum":71.55,"maximum":110.3,"gross_charge":135,"discounted_cash":30.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00015-7405-99","type":"NDC"}],"standard_charges":[{"minimum":0.73,"maximum":110.3,"gross_charge":135,"discounted_cash":30.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2GM/100ML IVPB","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0399-23","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2GM/100ML IVPB","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0399-23","type":"NDC"}],"standard_charges":[{"minimum":0.73,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"}]}]},{"description":"AMPICIL/SULB 1.5GM LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0116-10","type":"NDC"}],"standard_charges":[{"minimum":34.98,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"AMPICIL/SULB 1.5GM LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0116-10","type":"NDC"}],"standard_charges":[{"minimum":1.68,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"}]}]},{"description":"AMPICIL/SULB 3GM LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0032-21","type":"NDC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"AMPICIL/SULB 3GM LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0032-21","type":"NDC"}],"standard_charges":[{"minimum":1.68,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOL 20MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-6629-02","type":"NDC"}],"standard_charges":[{"minimum":88.51,"maximum":136.44,"gross_charge":167,"discounted_cash":38.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.44,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOL 20MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-6629-02","type":"NDC"}],"standard_charges":[{"minimum":0.82,"maximum":136.44,"gross_charge":167,"discounted_cash":38.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOL 20MG/ML 10ML SYR","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0919-10","type":"NDC"}],"standard_charges":[{"minimum":89.04,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOL 20MG/ML 10ML SYR","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0919-10","type":"NDC"}],"standard_charges":[{"minimum":0.82,"maximum":137.26,"gross_charge":168,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0400-25","type":"NDC"}],"standard_charges":[{"minimum":58.83,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0400-25","type":"NDC"}],"standard_charges":[{"minimum":4.18,"maximum":90.69,"gross_charge":111,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.18,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0019-82","type":"NDC"}],"standard_charges":[{"minimum":78.44,"maximum":120.92,"gross_charge":148,"discounted_cash":33.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0019-82","type":"NDC"}],"standard_charges":[{"minimum":2.18,"maximum":120.92,"gross_charge":148,"discounted_cash":33.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0019-82","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0019-82","type":"NDC"}],"standard_charges":[{"minimum":2.18,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1GM LYOPH SDVJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0401-20","type":"NDC"}],"standard_charges":[{"minimum":178.61,"maximum":275.33,"gross_charge":337,"discounted_cash":77.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":275.33,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1GM LYOPH SDVJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0401-20","type":"NDC"}],"standard_charges":[{"minimum":4.44,"maximum":275.33,"gross_charge":337,"discounted_cash":77.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":275.33,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 2GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0402-20","type":"NDC"}],"standard_charges":[{"minimum":361.99,"maximum":558.02,"gross_charge":683,"discounted_cash":156.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":361.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":558.02,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 2GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0402-20","type":"NDC"}],"standard_charges":[{"minimum":4.44,"maximum":558.02,"gross_charge":683,"discounted_cash":156.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":361.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":558.02,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1630-10","type":"NDC"}],"standard_charges":[{"minimum":31.8,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1630-10","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":49.02,"gross_charge":60,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-0401-25","type":"NDC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-0401-25","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6006-10","type":"NDC"}],"standard_charges":[{"minimum":190.27,"maximum":293.31,"gross_charge":359,"discounted_cash":82.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":293.31,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6006-10","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":293.31,"gross_charge":359,"discounted_cash":82.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":293.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-1001-25","type":"NDC"}],"standard_charges":[{"minimum":31.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-1001-25","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0441-05","type":"NDC"}],"standard_charges":[{"minimum":454.21,"maximum":700.17,"gross_charge":857,"discounted_cash":196.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":454.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":700.17,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0441-05","type":"NDC"}],"standard_charges":[{"minimum":15.27,"maximum":700.17,"gross_charge":857,"discounted_cash":196.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":41.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":41.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":20.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":454.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":700.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"}]}]},{"description":"BENZTROPINE 1MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0970-02","type":"NDC"}],"standard_charges":[{"minimum":297.33,"maximum":458.34,"gross_charge":561,"discounted_cash":128.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":297.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":458.34,"methodology":"fee schedule"}]}]},{"description":"BENZTROPINE 1MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0970-02","type":"NDC"}],"standard_charges":[{"minimum":17.31,"maximum":458.34,"gross_charge":561,"discounted_cash":128.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":297.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":458.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"}]}]},{"description":"PEN G BENZ 1.2MIL U 2ML INJ JW","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60793-0701-10","type":"NDC"}],"standard_charges":[{"minimum":826.8,"maximum":1274.52,"gross_charge":1560,"discounted_cash":357.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":826.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1274.52,"methodology":"fee schedule"}]}]},{"description":"PEN G BENZ 1.2MIL U 2ML INJ JW","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60793-0701-10","type":"NDC"}],"standard_charges":[{"minimum":17.81,"maximum":1274.52,"gross_charge":1560,"discounted_cash":357.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":87.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":87.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":826.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1274.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":31.55,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":32.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8MG ODT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0571","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00054-0177-13","type":"NDC"}],"standard_charges":[{"minimum":34.98,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8MG ODT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0571","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00054-0177-13","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHIN/NALOX 2/0.5MG ODT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0572","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65162-0416-03","type":"NDC"}],"standard_charges":[{"minimum":26.5,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHIN/NALOX 2/0.5MG ODT","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0572","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65162-0416-03","type":"NDC"}],"standard_charges":[{"minimum":3.74,"maximum":40.85,"gross_charge":50,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHIN/NALOX 4/1MG ODFLM","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0573","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"12496-1204-03","type":"NDC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHIN/NALOX 4/1MG ODFLM","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0573","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"12496-1204-03","type":"NDC"}],"standard_charges":[{"minimum":11.46,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"}]}]},{"description":"ONABOTULINUMTOXINA 200U SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0585","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00023-3921-02","type":"NDC"}],"standard_charges":[{"minimum":5676.3,"maximum":8750.07,"gross_charge":10710,"discounted_cash":2452.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5676.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8750.07,"methodology":"fee schedule"}]}]},{"description":"ONABOTULINUMTOXINA 200U SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0585","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00023-3921-02","type":"NDC"}],"standard_charges":[{"minimum":5.19,"maximum":8750.07,"gross_charge":10710,"discounted_cash":2452.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5676.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8750.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"}]}]},{"description":"BUTORPHANOL 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0595","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0317-45","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"BUTORPHANOL 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0595","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0317-45","type":"NDC"}],"standard_charges":[{"minimum":5.82,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"}]}]},{"description":"CA GLUCONAT(FRES)1GM/10MLSDVJW","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0360-19","type":"NDC"}],"standard_charges":[{"minimum":54.59,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"}]}]},{"description":"CA GLUCONAT(FRES)1GM/10MLSDVJW","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0360-19","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":84.16,"gross_charge":103,"discounted_cash":23.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.16,"methodology":"fee schedule"}]}]},{"description":"CA GLUCONATE 1GM/100ML PB","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61553-0053-48","type":"NDC"}],"standard_charges":[{"minimum":43.99,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"}]}]},{"description":"CA GLUCONATE 1GM/100ML PB","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61553-0053-48","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN 200IU/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"67457-0675-02","type":"NDC"}],"standard_charges":[{"minimum":14613.16,"maximum":22526.33,"gross_charge":27572,"discounted_cash":6313.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14613.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22526.33,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN 200IU/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"67457-0675-02","type":"NDC"}],"standard_charges":[{"minimum":876.99,"maximum":22526.33,"gross_charge":27572,"discounted_cash":6313.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4267.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4267.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6405.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4804.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4804.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1428,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1428,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14613.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22526.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":899.73,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":917.55,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":908.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":913.1,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":890.82,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CA 200MG SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0815-30","type":"NDC"}],"standard_charges":[{"minimum":216.24,"maximum":333.34,"gross_charge":408,"discounted_cash":93.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":216.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.34,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CA 200MG SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0815-30","type":"NDC"}],"standard_charges":[{"minimum":4.26,"maximum":333.34,"gross_charge":408,"discounted_cash":93.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":216.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"}]}]},{"description":"BUPIV PF 0.5% 150MG/30ML SDVJW","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1560-29","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"BUPIV PF 0.5% 150MG/30ML SDVJW","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1560-29","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"BUPIVAC PF 0.25% 75MG/30MLSDV","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0464-37","type":"NDC"}],"standard_charges":[{"minimum":40.81,"maximum":62.91,"gross_charge":77,"discounted_cash":17.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"}]}]},{"description":"BUPIVAC PF 0.25% 75MG/30MLSDV","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0464-37","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":62.91,"gross_charge":77,"discounted_cash":17.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.91,"methodology":"fee schedule"}]}]},{"description":"CEFAZOL(BAXT)ISO 1G/50MLPMXJW","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J0689","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-3503-41","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"CEFAZOL(BAXT)ISO 1G/50MLPMXJW","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J0689","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-3503-41","type":"NDC"}],"standard_charges":[{"minimum":2.25,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0240-10","type":"NDC"}],"standard_charges":[{"minimum":31.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0240-10","type":"NDC"}],"standard_charges":[{"minimum":1.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0122-50","type":"NDC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0122-50","type":"NDC"}],"standard_charges":[{"minimum":1.27,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 1GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0245-25","type":"NDC"}],"standard_charges":[{"minimum":32.86,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 1GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0245-25","type":"NDC"}],"standard_charges":[{"minimum":4.56,"maximum":50.66,"gross_charge":62,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9877-25","type":"NDC"}],"standard_charges":[{"minimum":107.06,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9877-25","type":"NDC"}],"standard_charges":[{"minimum":4.56,"maximum":165.04,"gross_charge":202,"discounted_cash":46.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":107.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.04,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"}]}]},{"description":"CEFTOLOZ/TAZOBACT 1.5GM SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0695","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67919-0030-01","type":"NDC"}],"standard_charges":[{"minimum":534.24,"maximum":823.54,"gross_charge":1008,"discounted_cash":230.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":534.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.54,"methodology":"fee schedule"}]}]},{"description":"CEFTOLOZ/TAZOBACT 1.5GM SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0695","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67919-0030-01","type":"NDC"}],"standard_charges":[{"minimum":6.05,"maximum":823.54,"gross_charge":1008,"discounted_cash":230.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":534.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":823.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 250MG PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6151-04","type":"NDC"}],"standard_charges":[{"minimum":72.08,"maximum":111.12,"gross_charge":136,"discounted_cash":31.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.12,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 250MG PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6151-04","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":111.12,"gross_charge":136,"discounted_cash":31.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":72.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 2GM LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0107-68","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 2GM LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0107-68","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 500MG PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6152-01","type":"NDC"}],"standard_charges":[{"minimum":121.37,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 500MG PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6152-01","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":187.1,"gross_charge":229,"discounted_cash":52.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"}]}]},{"description":"CEFTAROLINE FOSAM 600MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0712","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00456-0600-01","type":"NDC"}],"standard_charges":[{"minimum":222.07,"maximum":342.33,"gross_charge":419,"discounted_cash":95.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":222.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":342.33,"methodology":"fee schedule"}]}]},{"description":"CEFTAROLINE FOSAM 600MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0712","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00456-0600-01","type":"NDC"}],"standard_charges":[{"minimum":3.15,"maximum":342.33,"gross_charge":419,"discounted_cash":95.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":222.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":342.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 1GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0127-20","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 1GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0127-20","type":"NDC"}],"standard_charges":[{"minimum":1.69,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 2GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0236-10","type":"NDC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 2GM PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0236-10","type":"NDC"}],"standard_charges":[{"minimum":1.69,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"}]}]},{"description":"CEFTAZ/AVIB 2-0.5GM PWD SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0714","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00456-2700-10","type":"NDC"}],"standard_charges":[{"minimum":1533.82,"maximum":2364.4,"gross_charge":2894,"discounted_cash":662.73,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2364.4,"methodology":"fee schedule"}]}]},{"description":"CEFTAZ/AVIB 2-0.5GM PWD SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0714","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00456-2700-10","type":"NDC"}],"standard_charges":[{"minimum":78.27,"maximum":2364.4,"gross_charge":2894,"discounted_cash":662.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":432.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":324.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":324.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":183.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1533.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2364.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.27,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":112.98,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":115.22,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":114.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":114.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":111.86,"methodology":"fee schedule"}]}]},{"description":"ANTIVEN CENTRUR 120MG/5ML SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0716","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66621-0150-02","type":"NDC"}],"standard_charges":[{"minimum":9268.64,"maximum":14287.7,"gross_charge":17488,"discounted_cash":4004.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9268.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14287.7,"methodology":"fee schedule"}]}]},{"description":"ANTIVEN CENTRUR 120MG/5ML SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0716","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66621-0150-02","type":"NDC"}],"standard_charges":[{"minimum":3991.75,"maximum":22402.53,"gross_charge":17488,"discounted_cash":4004.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14926.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14926.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22402.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16804.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16804.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9364.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9364.29,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9268.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14287.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3991.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3991.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3991.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5178.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5230.62,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5334.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5282.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5178.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5178.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5178.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5308.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5178.83,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 300MG/50ML PB","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3288-09","type":"NDC"}],"standard_charges":[{"minimum":44.52,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 300MG/50ML PB","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3288-09","type":"NDC"}],"standard_charges":[{"minimum":2.9,"maximum":68.63,"gross_charge":84,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.63,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600MG 50ML PB","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3289-09","type":"NDC"}],"standard_charges":[{"minimum":67.31,"maximum":103.76,"gross_charge":127,"discounted_cash":29.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600MG 50ML PB","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3289-09","type":"NDC"}],"standard_charges":[{"minimum":2.9,"maximum":103.76,"gross_charge":127,"discounted_cash":29.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYC(BAX)900MG 50ML PBJW","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J0737","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-3814-24","type":"NDC"}],"standard_charges":[{"minimum":71.02,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYC(BAX)900MG 50ML PBJW","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J0737","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-3814-24","type":"NDC"}],"standard_charges":[{"minimum":3.01,"maximum":109.48,"gross_charge":134,"discounted_cash":30.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.48,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400MG/200ML PB","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0192-87","type":"NDC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400MG/200ML PB","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0192-87","type":"NDC"}],"standard_charges":[{"minimum":0.85,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZIN 5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0294-42","type":"NDC"}],"standard_charges":[{"minimum":100.17,"maximum":154.42,"gross_charge":189,"discounted_cash":43.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":154.42,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZIN 5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0294-42","type":"NDC"}],"standard_charges":[{"minimum":3.02,"maximum":154.42,"gross_charge":189,"discounted_cash":43.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":100.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":154.42,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"}]}]},{"description":"COSYNTROPIN(CORTROSYN) 0.25MG","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0834","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00548-5900-00","type":"NDC"}],"standard_charges":[{"minimum":576.64,"maximum":888.9,"gross_charge":1088,"discounted_cash":249.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":576.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":888.9,"methodology":"fee schedule"}]}]},{"description":"COSYNTROPIN(CORTROSYN) 0.25MG","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0834","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00548-5900-00","type":"NDC"}],"standard_charges":[{"minimum":34.27,"maximum":888.9,"gross_charge":1088,"discounted_cash":249.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":107.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":107.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":576.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":888.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.27,"methodology":"fee schedule"}]}]},{"description":"ANTIVEN CROTALID 120MG/10MLSDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0841","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66621-0790-02","type":"NDC"}],"standard_charges":[{"minimum":7135.92,"maximum":11000.09,"gross_charge":13464,"discounted_cash":3083.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7135.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11000.09,"methodology":"fee schedule"}]}]},{"description":"ANTIVEN CROTALID 120MG/10MLSDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0841","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66621-0790-02","type":"NDC"}],"standard_charges":[{"minimum":747.9,"maximum":11000.09,"gross_charge":13464,"discounted_cash":3083.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2474.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2474.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4493.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3370.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3370.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1827.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1827.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7135.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11000.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.9,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1112.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1123.99,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1146.25,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1135.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1112.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1112.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1112.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1140.69,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1112.86,"methodology":"fee schedule"}]}]},{"description":"DALBAVANCIN LYOPH 500MG SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0875","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57970-0100-01","type":"NDC"}],"standard_charges":[{"minimum":8054.94,"maximum":12416.77,"gross_charge":15198,"discounted_cash":3480.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8054.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12416.77,"methodology":"fee schedule"}]}]},{"description":"DALBAVANCIN LYOPH 500MG SDV JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0875","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57970-0100-01","type":"NDC"}],"standard_charges":[{"minimum":12.54,"maximum":12416.77,"gross_charge":15198,"discounted_cash":3480.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8054.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12416.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":17.07,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":16.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN LYOPHILIZ 500MG SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6229-04","type":"NDC"}],"standard_charges":[{"minimum":2408.32,"maximum":3712.45,"gross_charge":4544,"discounted_cash":1040.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2408.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3712.45,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN LYOPHILIZ 500MG SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6229-04","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":3712.45,"gross_charge":4544,"discounted_cash":1040.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2408.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3712.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"}]}]},{"description":"EPOETIN NONESRD 10KU SDV JW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0144-10","type":"NDC"}],"standard_charges":[{"minimum":1444.78,"maximum":2227.15,"gross_charge":2726,"discounted_cash":624.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1444.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2227.15,"methodology":"fee schedule"}]}]},{"description":"EPOETIN NONESRD 10KU SDV JW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0144-10","type":"NDC"}],"standard_charges":[{"minimum":7.29,"maximum":2227.15,"gross_charge":2726,"discounted_cash":624.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1444.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2227.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"}]}]},{"description":"EPOETIN NONESRD 4KU SDV JW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0304-01","type":"NDC"}],"standard_charges":[{"minimum":578.23,"maximum":891.35,"gross_charge":1091,"discounted_cash":249.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":578.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":891.35,"methodology":"fee schedule"}]}]},{"description":"EPOETIN NONESRD 4KU SDV JW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0304-01","type":"NDC"}],"standard_charges":[{"minimum":7.29,"maximum":891.35,"gross_charge":1091,"discounted_cash":249.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":578.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":891.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"}]}]},{"description":"METHYLPRED ACE 40MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-3073-01","type":"NDC"}],"standard_charges":[{"minimum":61.48,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"METHYLPRED ACE 40MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-3073-01","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":94.78,"gross_charge":116,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"DEXAMETH NA PH 4MG/1ML SDV","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6145-25","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"DEXAMETH NA PH 4MG/1ML SDV","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6145-25","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"DEXAMETH NA PH PF 10MG/1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0506-01","type":"NDC"}],"standard_charges":[{"minimum":33.92,"maximum":52.29,"gross_charge":64,"discounted_cash":14.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"}]}]},{"description":"DEXAMETH NA PH PF 10MG/1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0506-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":52.29,"gross_charge":64,"discounted_cash":14.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"DIHYDROERGOTAM 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1110","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81284-0411-05","type":"NDC"}],"standard_charges":[{"minimum":421.88,"maximum":650.34,"gross_charge":796,"discounted_cash":182.29,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":421.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":650.34,"methodology":"fee schedule"}]}]},{"description":"DIHYDROERGOTAM 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1110","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81284-0411-05","type":"NDC"}],"standard_charges":[{"minimum":42.07,"maximum":650.34,"gross_charge":796,"discounted_cash":182.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":276.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":276.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":169.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":421.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":650.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.07,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMID 500MG LYO SDV INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9503-01","type":"NDC"}],"standard_charges":[{"minimum":216.24,"maximum":333.34,"gross_charge":408,"discounted_cash":93.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":216.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.34,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMID 500MG LYO SDV INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9503-01","type":"NDC"}],"standard_charges":[{"minimum":22.16,"maximum":333.34,"gross_charge":408,"discounted_cash":93.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":61.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":61.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":30.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":216.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 0.25MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1160","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-1410-35","type":"NDC"}],"standard_charges":[{"minimum":30.21,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 0.25MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1160","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-1410-35","type":"NDC"}],"standard_charges":[{"minimum":7,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.04,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN IMMUN FAB 40MG PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50633-0120-11","type":"NDC"}],"standard_charges":[{"minimum":10676.85,"maximum":16458.47,"gross_charge":20145,"discounted_cash":4613.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10676.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16458.47,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN IMMUN FAB 40MG PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50633-0120-11","type":"NDC"}],"standard_charges":[{"minimum":3917.5,"maximum":21394.22,"gross_charge":20145,"discounted_cash":4613.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11780.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11780.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21394.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":16048.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":16048.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8695.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8695.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10676.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16458.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3917.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3917.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3917.5,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":5295.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":5348.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.48,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":5401.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":5295.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":5295.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":5295.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":5428.01,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":5295.61,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-0493-21","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-0493-21","type":"NDC"}],"standard_charges":[{"minimum":0.48,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-2552-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-2552-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50MG/ML 1MLINJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-0376-25","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50MG/ML 1MLINJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-0376-25","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 500MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1075-02","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 500MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1075-02","type":"NDC"}],"standard_charges":[{"minimum":7.57,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":26.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":26.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 400MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-7809-22","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 400MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-7809-22","type":"NDC"}],"standard_charges":[{"minimum":0.79,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE 100MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1271","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0130-11","type":"NDC"}],"standard_charges":[{"minimum":130.91,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE 100MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1271","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0130-11","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 10MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1308","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0739-12","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 10MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1308","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0739-12","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1GM PWDR INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0159-05","type":"NDC"}],"standard_charges":[{"minimum":432.48,"maximum":666.68,"gross_charge":816,"discounted_cash":186.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":432.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":666.68,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1GM PWDR INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0159-05","type":"NDC"}],"standard_charges":[{"minimum":11.29,"maximum":666.68,"gross_charge":816,"discounted_cash":186.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":432.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":666.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"}]}]},{"description":"ESTROGENS CONJ 25MG/5ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1410","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00046-0749-05","type":"NDC"}],"standard_charges":[{"minimum":910.54,"maximum":1403.61,"gross_charge":1718,"discounted_cash":393.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":910.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1403.61,"methodology":"fee schedule"}]}]},{"description":"ESTROGENS CONJ 25MG/5ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1410","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00046-0749-05","type":"NDC"}],"standard_charges":[{"minimum":305.16,"maximum":1648.69,"gross_charge":1718,"discounted_cash":393.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":907.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":907.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1648.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1236.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1236.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":683.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":683.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":910.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1403.61,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":416.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":420.63,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":428.96,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":424.79,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":416.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":416.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":416.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":426.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":416.46,"methodology":"fee schedule"}]}]},{"description":"FILGRAST 0.3MG/0.5MLSYRJW","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J1442","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0924-01","type":"NDC"}],"standard_charges":[{"minimum":1283.66,"maximum":1978.78,"gross_charge":2422,"discounted_cash":554.64,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1283.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1978.78,"methodology":"fee schedule"}]}]},{"description":"FILGRAST 0.3MG/0.5MLSYRJW","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J1442","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0924-01","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":1978.78,"gross_charge":2422,"discounted_cash":554.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1283.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1978.78,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200MG/100ML PB","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0184-82","type":"NDC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200MG/100ML PB","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0184-82","type":"NDC"}],"standard_charges":[{"minimum":2.45,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400MG/200ML PB","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-6045-37","type":"NDC"}],"standard_charges":[{"minimum":98.58,"maximum":151.97,"gross_charge":186,"discounted_cash":42.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.97,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400MG/200ML PB","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-6045-37","type":"NDC"}],"standard_charges":[{"minimum":2.45,"maximum":151.97,"gross_charge":186,"discounted_cash":42.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":98.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"}]}]},{"description":"FOMEPIZOLE 1GM/ML 1.5ML INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0829-02","type":"NDC"}],"standard_charges":[{"minimum":5324.91,"maximum":8208.4,"gross_charge":10047,"discounted_cash":2300.77,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5324.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8208.4,"methodology":"fee schedule"}]}]},{"description":"FOMEPIZOLE 1GM/ML 1.5ML INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0829-02","type":"NDC"}],"standard_charges":[{"minimum":4.96,"maximum":8208.4,"gross_charge":10047,"discounted_cash":2300.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":22.56,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5324.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8208.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 80MG INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1207-03","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 80MG INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1207-03","type":"NDC"}],"standard_charges":[{"minimum":2.53,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLA 0.2MG/1ML INJJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9682-25","type":"NDC"}],"standard_charges":[{"minimum":81.09,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLA 0.2MG/1ML INJJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9682-25","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLA 0.2MG/ML5ML INJJW","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9680-25","type":"NDC"}],"standard_charges":[{"minimum":310.05,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLA 0.2MG/ML5ML INJJW","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9680-25","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":477.95,"gross_charge":585,"discounted_cash":133.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":310.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":477.95,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 1MG/5ML SYRJW","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-6015-03","type":"NDC"}],"standard_charges":[{"minimum":86.92,"maximum":133.99,"gross_charge":164,"discounted_cash":37.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.99,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 1MG/5ML SYRJW","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-6015-03","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":133.99,"gross_charge":164,"discounted_cash":37.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.99,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON RECOMB 1MG/1ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0594-03","type":"NDC"}],"standard_charges":[{"minimum":700.66,"maximum":1080.08,"gross_charge":1322,"discounted_cash":302.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":700.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1080.08,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON RECOMB 1MG/1ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0594-03","type":"NDC"}],"standard_charges":[{"minimum":154.46,"maximum":1080.08,"gross_charge":1322,"discounted_cash":302.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":452.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":452.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":821.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":616.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":616.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":342.63,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":700.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1080.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":208.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":210.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":214.95,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":212.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":208.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":208.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":208.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":213.9,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":208.68,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0806-01","type":"NDC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0806-01","type":"NDC"}],"standard_charges":[{"minimum":1.24,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"}]}]},{"description":"HEPARIN FL 30U/3ML SYR","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"08290-3065-21","type":"NDC"}],"standard_charges":[{"minimum":3.18,"maximum":4.91,"gross_charge":6,"discounted_cash":1.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"}]}]},{"description":"HEPARIN FL 30U/3ML SYR","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"08290-3065-21","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":4.91,"gross_charge":6,"discounted_cash":1.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"}]}]},{"description":"HEPARIN FL 500U/5ML SYR","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"08290-3064-24","type":"NDC"}],"standard_charges":[{"minimum":2.65,"maximum":4.09,"gross_charge":5,"discounted_cash":1.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"}]}]},{"description":"HEPARIN FL 500U/5ML SYR","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"08290-3064-24","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":4.09,"gross_charge":5,"discounted_cash":1.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"}]}]},{"description":"HEPAR 25KU/NS 0.45% 250ML PMX","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-7650-62","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"HEPAR 25KU/NS 0.45% 250ML PMX","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-7650-62","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"HEPARIN 5KU/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0262-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"HEPARIN 5KU/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0262-01","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100MG 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0623-00","type":"NDC"}],"standard_charges":[{"minimum":447.85,"maximum":690.37,"gross_charge":845,"discounted_cash":193.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":447.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":690.37,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100MG 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0623-00","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":690.37,"gross_charge":845,"discounted_cash":193.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":447.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":690.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120MG/0.8ML INJ","drug_information": {"unit": 0.8,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-2912-01","type":"NDC"}],"standard_charges":[{"minimum":537.42,"maximum":828.44,"gross_charge":1014,"discounted_cash":232.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":537.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":828.44,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120MG/0.8ML INJ","drug_information": {"unit": 0.8,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-2912-01","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":828.44,"gross_charge":1014,"discounted_cash":232.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":537.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":828.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150MG/1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-2915-01","type":"NDC"}],"standard_charges":[{"minimum":672.04,"maximum":1035.96,"gross_charge":1268,"discounted_cash":290.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":672.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1035.96,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150MG/1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-2915-01","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":1035.96,"gross_charge":1268,"discounted_cash":290.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":672.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1035.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30MG 0.3ML INJ","drug_information": {"unit": 0.3,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0624-30","type":"NDC"}],"standard_charges":[{"minimum":134.62,"maximum":207.52,"gross_charge":254,"discounted_cash":58.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":207.52,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30MG 0.3ML INJ","drug_information": {"unit": 0.3,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0624-30","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":207.52,"gross_charge":254,"discounted_cash":58.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":134.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":207.52,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40MG 0.4ML INJ","drug_information": {"unit": 0.4,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0620-40","type":"NDC"}],"standard_charges":[{"minimum":179.14,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40MG 0.4ML INJ","drug_information": {"unit": 0.4,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0620-40","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60MG 0.6ML INJ","drug_information": {"unit": 0.6,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0621-60","type":"NDC"}],"standard_charges":[{"minimum":268.71,"maximum":414.22,"gross_charge":507,"discounted_cash":116.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":268.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.22,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60MG 0.6ML INJ","drug_information": {"unit": 0.6,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0621-60","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":414.22,"gross_charge":507,"discounted_cash":116.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":268.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80MG 0.8ML INJ","drug_information": {"unit": 0.8,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0622-80","type":"NDC"}],"standard_charges":[{"minimum":358.28,"maximum":552.3,"gross_charge":676,"discounted_cash":154.81,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":358.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":552.3,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80MG 0.8ML INJ","drug_information": {"unit": 0.8,"type": "ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00075-0622-80","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":552.3,"gross_charge":676,"discounted_cash":154.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":358.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":552.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5MG 0.5ML SYRN","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00787-3443-94","type":"NDC"}],"standard_charges":[{"minimum":246.45,"maximum":379.91,"gross_charge":465,"discounted_cash":106.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":246.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.91,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5MG 0.5ML SYRN","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00787-3443-94","type":"NDC"}],"standard_charges":[{"minimum":0.69,"maximum":379.91,"gross_charge":465,"discounted_cash":106.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":246.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"}]}]},{"description":"IG TETANUS IMMUN GLOB 250U SYR","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1670","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0634-02","type":"NDC"}],"standard_charges":[{"minimum":2041.56,"maximum":3147.09,"gross_charge":3852,"discounted_cash":882.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2041.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3147.09,"methodology":"fee schedule"}]}]},{"description":"IG TETANUS IMMUN GLOB 250U SYR","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1670","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0634-02","type":"NDC"}],"standard_charges":[{"minimum":474.46,"maximum":3147.09,"gross_charge":3852,"discounted_cash":882.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1365.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1365.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2479.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1859.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1859.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1009.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1009.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2041.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3147.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":615.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":621.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":633.49,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":627.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":615.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":615.03,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":615.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":630.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":615.03,"methodology":"fee schedule"}]}]},{"description":"HYDROCORT NA SUC 100MG/2ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0011-03","type":"NDC"}],"standard_charges":[{"minimum":33.92,"maximum":52.29,"gross_charge":64,"discounted_cash":14.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"}]}]},{"description":"HYDROCORT NA SUC 100MG/2ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0011-03","type":"NDC"}],"standard_charges":[{"minimum":21.46,"maximum":88.6,"gross_charge":64,"discounted_cash":14.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":66.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":66.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"}]}]},{"description":"IRON SUCROSE 20MG/ML 5ML SDV","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1756","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-2340-25","type":"NDC"}],"standard_charges":[{"minimum":331.25,"maximum":510.63,"gross_charge":625,"discounted_cash":143.13,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":331.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":510.63,"methodology":"fee schedule"}]}]},{"description":"IRON SUCROSE 20MG/ML 5ML SDV","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1756","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-2340-25","type":"NDC"}],"standard_charges":[{"minimum":0.24,"maximum":510.63,"gross_charge":625,"discounted_cash":143.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":331.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":510.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"DROPERIDOL 2.5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1790","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-9702-25","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"DROPERIDOL 2.5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J1790","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-9702-25","type":"NDC"}],"standard_charges":[{"minimum":9.38,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9872-10","type":"NDC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9872-10","type":"NDC"}],"standard_charges":[{"minimum":9.98,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 10MG/ML 10ML INJJW","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0115-01","type":"NDC"}],"standard_charges":[{"minimum":115.54,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 10MG/ML 10ML INJJW","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0115-01","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":178.11,"gross_charge":218,"discounted_cash":49.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.11,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 10MG/ML 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0055-61","type":"NDC"}],"standard_charges":[{"minimum":2528.63,"maximum":3897.91,"gross_charge":4771,"discounted_cash":1092.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2528.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3897.91,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 10MG/ML 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0055-61","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":3897.91,"gross_charge":4771,"discounted_cash":1092.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2528.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3897.91,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID 5MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J1808","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0184-10","type":"NDC"}],"standard_charges":[{"minimum":345.56,"maximum":532.69,"gross_charge":652,"discounted_cash":149.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":345.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":532.69,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID 5MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J1808","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0184-10","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":532.69,"gross_charge":652,"discounted_cash":149.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":345.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":532.69,"methodology":"fee schedule"}]}]},{"description":"INS NPH 10U/0.1ML 0.1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-8315-17","type":"NDC"}],"standard_charges":[{"minimum":8.48,"maximum":13.08,"gross_charge":16,"discounted_cash":3.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"}]}]},{"description":"INS NPH 10U/0.1ML 0.1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-8315-17","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":13.08,"gross_charge":16,"discounted_cash":3.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"INSULIN GLARGINE 10U/0.1MLSYRG","drug_information": {"unit": 0.1,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"49502-0250-80","type":"NDC"}],"standard_charges":[{"minimum":14.84,"maximum":22.88,"gross_charge":28,"discounted_cash":6.42,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"}]}]},{"description":"INSULIN GLARGINE 10U/0.1MLSYRG","drug_information": {"unit": 0.1,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"49502-0250-80","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":22.88,"gross_charge":28,"discounted_cash":6.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"INSULIN LISPRO 10U/0.1ML SYR","drug_information": {"unit": 0.1,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-8799-59","type":"NDC"}],"standard_charges":[{"minimum":15.37,"maximum":23.7,"gross_charge":29,"discounted_cash":6.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"}]}]},{"description":"INSULIN LISPRO 10U/0.1ML SYR","drug_information": {"unit": 0.1,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-8799-59","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":23.7,"gross_charge":29,"discounted_cash":6.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"INSULIN REG 100U/NS 100ML PMX","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00338-0126-12","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"INSULIN REG 100U/NS 100ML PMX","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00338-0126-12","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"INSULIN REG 10U/0.1ML INJ","drug_information": {"unit": 0.1,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-8215-17","type":"NDC"}],"standard_charges":[{"minimum":7.95,"maximum":12.26,"gross_charge":15,"discounted_cash":3.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"}]}]},{"description":"INSULIN REG 10U/0.1ML INJ","drug_information": {"unit": 0.1,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00002-8215-17","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":12.26,"gross_charge":15,"discounted_cash":3.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"INSULIN REG HUM 100U/ML 10ML","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00169-1833-11","type":"NDC"}],"standard_charges":[{"minimum":539.01,"maximum":830.89,"gross_charge":1017,"discounted_cash":232.9,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":539.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":830.89,"methodology":"fee schedule"}]}]},{"description":"INSULIN REG HUM 100U/ML 10ML","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"00169-1833-11","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":830.89,"gross_charge":1017,"discounted_cash":232.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":539.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":830.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500MG/100ML PBJW","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1055-48","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500MG/100ML PBJW","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1055-48","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30MG/ML 1ML INJ JW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-3795-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30MG/ML 1ML INJ JW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-3795-01","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5MG(100MG)MDV","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0146-01","type":"NDC"}],"standard_charges":[{"minimum":34.45,"maximum":53.11,"gross_charge":65,"discounted_cash":14.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5MG(100MG)MDV","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0146-01","type":"NDC"}],"standard_charges":[{"minimum":0.68,"maximum":53.11,"gross_charge":65,"discounted_cash":14.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5MG/ML 4ML INJJW","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0717-00","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5MG/ML 4ML INJJW","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0717-00","type":"NDC"}],"standard_charges":[{"minimum":0.68,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 40MG/4ML INJ","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J1938","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0323-25","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 40MG/4ML INJ","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J1938","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0323-25","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25MG/ML 4ML INJJW","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J1939","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6008-10","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25MG/ML 4ML INJJW","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J1939","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6008-10","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 100MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0106-10","type":"NDC"}],"standard_charges":[{"minimum":50.88,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 100MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0106-10","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":78.44,"gross_charge":96,"discounted_cash":21.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750MG 150ML PB","drug_information": {"unit": 150,"type": "ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0048-24","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750MG 150ML PB","drug_information": {"unit": 150,"type": "ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0048-24","type":"NDC"}],"standard_charges":[{"minimum":1.94,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.5MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1980","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0111-05","type":"NDC"}],"standard_charges":[{"minimum":324.36,"maximum":500.01,"gross_charge":612,"discounted_cash":140.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":324.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.01,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.5MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J1980","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0111-05","type":"NDC"}],"standard_charges":[{"minimum":55.35,"maximum":500.01,"gross_charge":612,"discounted_cash":140.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":172.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":172.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":324.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.35,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 0.4% 1GM/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-9594-20","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 0.4% 1GM/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-9594-20","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"LIDOCAI 0.4% 2GM/D5W500ML PBJW","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"J2002","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0409-03","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"LIDOCAI 0.4% 2GM/D5W500ML PBJW","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"J2002","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0409-03","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE MPF 1% 20MG/2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0492-27","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE MPF 1% 20MG/2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0492-27","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE MPF 4% 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83090-0007-10","type":"NDC"}],"standard_charges":[{"minimum":48.23,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE MPF 4% 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83090-0007-10","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":74.35,"gross_charge":91,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.35,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE PF 2% 100MG/5ML SYRN","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-4903-34","type":"NDC"}],"standard_charges":[{"minimum":33.92,"maximum":52.29,"gross_charge":64,"discounted_cash":14.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE PF 2% 100MG/5ML SYRN","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-4903-34","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":52.29,"gross_charge":64,"discounted_cash":14.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.29,"methodology":"fee schedule"}]}]},{"description":"LIDO/EPI 1%-1:100K1ML(20ML)MDV","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-3178-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"LIDO/EPI 1%-1:100K1ML(20ML)MDV","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-3178-01","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600MG/300ML PB","drug_information": {"unit": 300,"type": "ML"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9534-10","type":"NDC"}],"standard_charges":[{"minimum":189.21,"maximum":291.67,"gross_charge":357,"discounted_cash":81.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.67,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600MG/300ML PB","drug_information": {"unit": 300,"type": "ML"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9534-10","type":"NDC"}],"standard_charges":[{"minimum":3.05,"maximum":291.67,"gross_charge":357,"discounted_cash":81.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":189.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6044-25","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6044-25","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 25% 50ML INJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J2150","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0024-25","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 25% 50ML INJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J2150","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0024-25","type":"NDC"}],"standard_charges":[{"minimum":2.6,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1178-30","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1178-30","type":"NDC"}],"standard_charges":[{"minimum":7.13,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":32.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":32.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1GM SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0508-25","type":"NDC"}],"standard_charges":[{"minimum":83.74,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1GM SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0508-25","type":"NDC"}],"standard_charges":[{"minimum":0.4,"maximum":129.09,"gross_charge":158,"discounted_cash":36.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500MG SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3000-95","type":"NDC"}],"standard_charges":[{"minimum":82.15,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500MG SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3000-95","type":"NDC"}],"standard_charges":[{"minimum":0.4,"maximum":126.64,"gross_charge":155,"discounted_cash":35.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"METHYLERGONOV 0.2MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2210","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-0740-20","type":"NDC"}],"standard_charges":[{"minimum":146.81,"maximum":226.31,"gross_charge":277,"discounted_cash":63.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":226.31,"methodology":"fee schedule"}]}]},{"description":"METHYLERGONOV 0.2MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2210","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-0740-20","type":"NDC"}],"standard_charges":[{"minimum":22.37,"maximum":226.31,"gross_charge":277,"discounted_cash":63.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.48,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":68.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":68.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":146.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":226.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"}]}]},{"description":"METHYLNALTREXONE 12MG/0.6MLSYR","drug_information": {"unit": 0.6,"type": "ML"},"code_information":[{"code":"J2212","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65649-0551-07","type":"NDC"}],"standard_charges":[{"minimum":832.1,"maximum":1282.69,"gross_charge":1570,"discounted_cash":359.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":832.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1282.69,"methodology":"fee schedule"}]}]},{"description":"METHYLNALTREXONE 12MG/0.6MLSYR","drug_information": {"unit": 0.6,"type": "ML"},"code_information":[{"code":"J2212","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"65649-0551-07","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":1282.69,"gross_charge":1570,"discounted_cash":359.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":832.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1282.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00469-3211-10","type":"NDC"}],"standard_charges":[{"minimum":1011.24,"maximum":1558.84,"gross_charge":1908,"discounted_cash":436.94,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1011.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1558.84,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00469-3211-10","type":"NDC"}],"standard_charges":[{"minimum":0.29,"maximum":1558.84,"gross_charge":1908,"discounted_cash":436.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1011.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1558.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1MG/0.2ML INJ","drug_information": {"unit": 0.2,"type": "ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6060-10","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":1.64,"gross_charge":2,"discounted_cash":0.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1MG/0.2ML INJ","drug_information": {"unit": 0.2,"type": "ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6060-10","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":1.64,"gross_charge":2,"discounted_cash":0.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0600-02","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0600-02","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5MG/ML 1ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6060-10","type":"NDC"}],"standard_charges":[{"minimum":45.05,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5MG/ML 1ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6060-10","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20MG/100ML PB","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9719-10","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20MG/100ML PB","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9719-10","type":"NDC"}],"standard_charges":[{"minimum":1.34,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 100MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2265","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0160-10","type":"NDC"}],"standard_charges":[{"minimum":1397.61,"maximum":2154.43,"gross_charge":2637,"discounted_cash":603.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1397.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2154.43,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 100MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2265","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0160-10","type":"NDC"}],"standard_charges":[{"minimum":2.02,"maximum":2154.43,"gross_charge":2637,"discounted_cash":603.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1397.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2154.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1890-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1890-01","type":"NDC"}],"standard_charges":[{"minimum":4.69,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 50MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J2305","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1049-02","type":"NDC"}],"standard_charges":[{"minimum":121.9,"maximum":187.91,"gross_charge":230,"discounted_cash":52.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.91,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 50MG/250ML PB","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J2305","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1049-02","type":"NDC"}],"standard_charges":[{"minimum":2.4,"maximum":187.91,"gross_charge":230,"discounted_cash":52.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":121.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.91,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1219-01","type":"NDC"}],"standard_charges":[{"minimum":642.36,"maximum":990.21,"gross_charge":1212,"discounted_cash":277.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":642.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":990.21,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1219-01","type":"NDC"}],"standard_charges":[{"minimum":8.92,"maximum":990.21,"gross_charge":1212,"discounted_cash":277.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":642.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":990.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1215-01","type":"NDC"}],"standard_charges":[{"minimum":119.25,"maximum":183.83,"gross_charge":225,"discounted_cash":51.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":119.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.83,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1215-01","type":"NDC"}],"standard_charges":[{"minimum":8.92,"maximum":183.83,"gross_charge":225,"discounted_cash":51.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":119.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 1MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-1469-01","type":"NDC"}],"standard_charges":[{"minimum":178.61,"maximum":275.33,"gross_charge":337,"discounted_cash":77.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":275.33,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 1MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-1469-01","type":"NDC"}],"standard_charges":[{"minimum":8.92,"maximum":275.33,"gross_charge":337,"discounted_cash":77.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":178.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":275.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE 100MCG/1MLSQINJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"63323-0376-04","type":"NDC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE 100MCG/1MLSQINJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"63323-0376-04","type":"NDC"}],"standard_charges":[{"minimum":0.83,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE 500MCG/1MLIV","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0377-04","type":"NDC"}],"standard_charges":[{"minimum":179.14,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE 500MCG/1MLIV","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0377-04","type":"NDC"}],"standard_charges":[{"minimum":0.83,"maximum":276.15,"gross_charge":338,"discounted_cash":77.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":179.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE 500MCG/1MLSQINJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"63323-0377-01","type":"NDC"}],"standard_charges":[{"minimum":268.71,"maximum":414.22,"gross_charge":507,"discounted_cash":116.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":268.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.22,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE 500MCG/1MLSQINJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"63323-0377-01","type":"NDC"}],"standard_charges":[{"minimum":0.83,"maximum":414.22,"gross_charge":507,"discounted_cash":116.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":268.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 10MG LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2359","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00002-7597-01","type":"NDC"}],"standard_charges":[{"minimum":232.14,"maximum":357.85,"gross_charge":438,"discounted_cash":100.31,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":232.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":357.85,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 10MG LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2359","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00002-7597-01","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":357.85,"gross_charge":438,"discounted_cash":100.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":232.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":357.85,"methodology":"fee schedule"}]}]},{"description":"ORPHENADRINE 30MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0651-02","type":"NDC"}],"standard_charges":[{"minimum":65.19,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"}]}]},{"description":"ORPHENADRINE 30MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0651-02","type":"NDC"}],"standard_charges":[{"minimum":14.34,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.1,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPH 1% 10MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6142-25","type":"NDC"}],"standard_charges":[{"minimum":65.19,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPH 1% 10MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6142-25","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":100.5,"gross_charge":123,"discounted_cash":28.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":65.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPH 1% 10MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0505-10","type":"NDC"}],"standard_charges":[{"minimum":91.69,"maximum":141.35,"gross_charge":173,"discounted_cash":39.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.35,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPH 1% 10MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0505-10","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":141.35,"gross_charge":173,"discounted_cash":39.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":91.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.35,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 2.5MG/ML 10ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J2404","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9689-10","type":"NDC"}],"standard_charges":[{"minimum":92.22,"maximum":142.16,"gross_charge":174,"discounted_cash":39.85,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":92.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":142.16,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 2.5MG/ML 10ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J2404","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9689-10","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":142.16,"gross_charge":174,"discounted_cash":39.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":92.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":142.16,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 40MG/200ML PB","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"J2404","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9633-10","type":"NDC"}],"standard_charges":[{"minimum":1099.22,"maximum":1694.46,"gross_charge":2074,"discounted_cash":474.95,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1099.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1694.46,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 40MG/200ML PB","drug_information": {"unit": 200,"type": "ML"},"code_information":[{"code":"J2404","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9633-10","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":1694.46,"gross_charge":2074,"discounted_cash":474.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1099.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1694.46,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 2MG/ML 2ML SDV","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6130-05","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 2MG/ML 2ML SDV","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6130-05","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40MG LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00008-4001-25","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40MG LYOPH SDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00008-4001-25","type":"NDC"}],"standard_charges":[{"minimum":3.38,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G K 5MIL UNIT INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-6135-95","type":"NDC"}],"standard_charges":[{"minimum":190.27,"maximum":293.31,"gross_charge":359,"discounted_cash":82.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":293.31,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G K 5MIL UNIT INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-6135-95","type":"NDC"}],"standard_charges":[{"minimum":0.77,"maximum":293.31,"gross_charge":359,"discounted_cash":82.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":190.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":293.31,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"PIPERAC/TAZO 3.375GM/NS 50MLAE","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00206-8854-16","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"PIPERAC/TAZO 3.375GM/NS 50MLAE","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00206-8854-16","type":"NDC"}],"standard_charges":[{"minimum":1.17,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"PIPERACIL/TAZO 3.375GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-3385-13","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"PIPERACIL/TAZO 3.375GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-3385-13","type":"NDC"}],"standard_charges":[{"minimum":1.17,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"PIPERACIL/TAZO 3.375GM/100MLPB","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00206-8854-16","type":"NDC"}],"standard_charges":[{"minimum":218.89,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"}]}]},{"description":"PIPERACIL/TAZO 3.375GM/100MLPB","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00206-8854-16","type":"NDC"}],"standard_charges":[{"minimum":1.17,"maximum":337.43,"gross_charge":413,"discounted_cash":94.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":218.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":337.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN/TAZO 2.25GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61990-0110-02","type":"NDC"}],"standard_charges":[{"minimum":31.27,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN/TAZO 2.25GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61990-0110-02","type":"NDC"}],"standard_charges":[{"minimum":1.17,"maximum":48.21,"gross_charge":59,"discounted_cash":13.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":31.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25MG INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2550","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-0928-25","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25MG INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2550","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-0928-25","type":"NDC"}],"standard_charges":[{"minimum":3.66,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"}]}]},{"description":"PHENOBARB 130MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2560","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-0477-25","type":"NDC"}],"standard_charges":[{"minimum":306.34,"maximum":472.23,"gross_charge":578,"discounted_cash":132.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":306.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":472.23,"methodology":"fee schedule"}]}]},{"description":"PHENOBARB 130MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2560","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-0477-25","type":"NDC"}],"standard_charges":[{"minimum":31.53,"maximum":472.23,"gross_charge":578,"discounted_cash":132.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.8,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":95.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":95.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":306.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":472.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.53,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10U/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0012-10","type":"NDC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10U/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0012-10","type":"NDC"}],"standard_charges":[{"minimum":1.44,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10U/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0116-83","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10U/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0116-83","type":"NDC"}],"standard_charges":[{"minimum":1.44,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4MCG/ML 1MLINJ JW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55566-2200-00","type":"NDC"}],"standard_charges":[{"minimum":378.95,"maximum":584.16,"gross_charge":715,"discounted_cash":163.74,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":378.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":584.16,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4MCG/ML 1MLINJ JW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55566-2200-00","type":"NDC"}],"standard_charges":[{"minimum":4.15,"maximum":584.16,"gross_charge":715,"discounted_cash":163.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":378.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":584.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20U/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0164-25","type":"NDC"}],"standard_charges":[{"minimum":1148.51,"maximum":1770.44,"gross_charge":2167,"discounted_cash":496.25,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1148.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1770.44,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20U/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0164-25","type":"NDC"}],"standard_charges":[{"minimum":2.21,"maximum":1770.44,"gross_charge":2167,"discounted_cash":496.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1148.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1770.44,"methodology":"fee schedule"}]}]},{"description":"PROCAINAMIDE 500MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1903-01","type":"NDC"}],"standard_charges":[{"minimum":245.92,"maximum":379.09,"gross_charge":464,"discounted_cash":106.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.09,"methodology":"fee schedule"}]}]},{"description":"PROCAINAMIDE 500MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1903-01","type":"NDC"}],"standard_charges":[{"minimum":119.98,"maximum":1224.35,"gross_charge":464,"discounted_cash":106.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":674.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":674.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1224.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":918.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":918.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":340.06,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":207.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":209.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":213.33,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":211.26,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":207.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":207.11,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":207.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":212.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":207.11,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 1GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3099-95","type":"NDC"}],"standard_charges":[{"minimum":60.95,"maximum":93.96,"gross_charge":115,"discounted_cash":26.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 1GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3099-95","type":"NDC"}],"standard_charges":[{"minimum":1.1,"maximum":93.96,"gross_charge":115,"discounted_cash":26.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2GM INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3101-95","type":"NDC"}],"standard_charges":[{"minimum":75.79,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2GM INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3101-95","type":"NDC"}],"standard_charges":[{"minimum":1.1,"maximum":116.84,"gross_charge":143,"discounted_cash":32.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0345-44","type":"NDC"}],"standard_charges":[{"minimum":30.21,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0345-44","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":46.57,"gross_charge":57,"discounted_cash":13.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL SULF FREE500MG/50MLIV","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-59","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL SULF FREE500MG/50MLIV","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-59","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMIN 10MG/10ML /0.5MGMDV","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0501-11","type":"NDC"}],"standard_charges":[{"minimum":2.65,"maximum":4.09,"gross_charge":5,"discounted_cash":1.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMIN 10MG/10ML /0.5MGMDV","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0501-11","type":"NDC"}],"standard_charges":[{"minimum":0.82,"maximum":4.09,"gross_charge":5,"discounted_cash":1.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE 5MG/5ML /0.5MG MDV","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"31722-0995-31","type":"NDC"}],"standard_charges":[{"minimum":92.75,"maximum":142.98,"gross_charge":175,"discounted_cash":40.08,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":92.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":142.98,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE 5MG/5ML /0.5MG MDV","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"31722-0995-31","type":"NDC"}],"standard_charges":[{"minimum":0.82,"maximum":142.98,"gross_charge":175,"discounted_cash":40.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":92.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":142.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"}]}]},{"description":"PROTAMINE SULF 10MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0229-05","type":"NDC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"PROTAMINE SULF 10MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0229-05","type":"NDC"}],"standard_charges":[{"minimum":1.17,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"PHENTOLAMINE 5MG 1ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2760","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9564-10","type":"NDC"}],"standard_charges":[{"minimum":810.9,"maximum":1250.01,"gross_charge":1530,"discounted_cash":350.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":810.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.01,"methodology":"fee schedule"}]}]},{"description":"PHENTOLAMINE 5MG 1ML INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2760","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9564-10","type":"NDC"}],"standard_charges":[{"minimum":366.38,"maximum":1934.65,"gross_charge":1530,"discounted_cash":350.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1065.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1065.29,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1934.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1451.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1451.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":763.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":763.89,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":810.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":465.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":469.9,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":479.2,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":474.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":465.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":465.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":465.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":476.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":465.24,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-3414-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-3414-01","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"}]}]},{"description":"QUINUPRIS/DALFOPRIST 500MG SDV","drug_information": {"unit": 1,"type": "EA"},"code_information":[{"code":"J2770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61570-0260-10","type":"NDC"}],"standard_charges":[{"minimum":1372.17,"maximum":2115.22,"gross_charge":2589,"discounted_cash":592.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1372.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2115.22,"methodology":"fee schedule"}]}]},{"description":"QUINUPRIS/DALFOPRIST 500MG SDV","drug_information": {"unit": 1,"type": "EA"},"code_information":[{"code":"J2770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61570-0260-10","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":2115.22,"gross_charge":2589,"discounted_cash":592.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1325.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1325.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1990,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1492.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1492.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":831.83,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1372.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2115.22,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"}]}]},{"description":"IG RHO-D RHOPHYLAC 1.5KIU IV","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2791","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0300-01","type":"NDC"}],"standard_charges":[{"minimum":903.65,"maximum":1392.99,"gross_charge":1705,"discounted_cash":390.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":903.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1392.99,"methodology":"fee schedule"}]}]},{"description":"IG RHO-D RHOPHYLAC 1.5KIU IV","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J2791","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0300-01","type":"NDC"}],"standard_charges":[{"minimum":5.01,"maximum":1392.99,"gross_charge":1705,"discounted_cash":390.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":903.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1392.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE 2MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-20","type":"NDC"}],"standard_charges":[{"minimum":52.47,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE 2MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-20","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":80.89,"gross_charge":99,"discounted_cash":22.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE 5MG/ML 30ML INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0707-10","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE 5MG/ML 30ML INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0707-10","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAML 100MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0273-10","type":"NDC"}],"standard_charges":[{"minimum":321.18,"maximum":495.11,"gross_charge":606,"discounted_cash":138.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":321.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":495.11,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAML 100MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0273-10","type":"NDC"}],"standard_charges":[{"minimum":6.73,"maximum":495.11,"gross_charge":606,"discounted_cash":138.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":321.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":495.11,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"}]}]},{"description":"SINCALIDE 5MCG SDV","code_information":[{"code":"J2805","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":451.03,"maximum":695.27,"gross_charge":851,"discounted_cash":194.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":451.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":695.27,"methodology":"fee schedule"}]}]},{"description":"SINCALIDE 5MCG SDV","code_information":[{"code":"J2805","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":117.25,"maximum":695.27,"gross_charge":851,"discounted_cash":194.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":339.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":339.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":616.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":462.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":462.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":237.95,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":451.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":695.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.25,"methodology":"fee schedule"}]}]},{"description":"FERRIC GLUCONAT 62.5MG/5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2916","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00024-2794-10","type":"NDC"}],"standard_charges":[{"minimum":171.72,"maximum":264.71,"gross_charge":324,"discounted_cash":74.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.71,"methodology":"fee schedule"}]}]},{"description":"FERRIC GLUCONAT 62.5MG/5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J2916","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00024-2794-10","type":"NDC"}],"standard_charges":[{"minimum":2.04,"maximum":264.71,"gross_charge":324,"discounted_cash":74.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":6.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":6.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.82,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"}]}]},{"description":"METHYLPRED NA SUC PF125MGSDVJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0047-22","type":"NDC"}],"standard_charges":[{"minimum":29.15,"maximum":44.94,"gross_charge":55,"discounted_cash":12.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"}]}]},{"description":"METHYLPRED NA SUC PF125MGSDVJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0047-22","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":44.94,"gross_charge":55,"discounted_cash":12.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOL NA 40MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0255-03","type":"NDC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOL NA 40MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0255-03","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOL NA PF40MGSDVJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0039-28","type":"NDC"}],"standard_charges":[{"minimum":34.98,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOL NA PF40MGSDVJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0039-28","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOL NA125MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0258-03","type":"NDC"}],"standard_charges":[{"minimum":63.07,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOL NA125MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0258-03","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":97.23,"gross_charge":119,"discounted_cash":27.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.23,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLON NA 500MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0758-01","type":"NDC"}],"standard_charges":[{"minimum":131.44,"maximum":202.62,"gross_charge":248,"discounted_cash":56.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":202.62,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLON NA 500MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0758-01","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":202.62,"gross_charge":248,"discounted_cash":56.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":202.62,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLON NA1GM INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0698-01","type":"NDC"}],"standard_charges":[{"minimum":127.2,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLON NA1GM INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0698-01","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":196.08,"gross_charge":240,"discounted_cash":54.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"}]}]},{"description":"ALTEPLASE 2MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0041-64","type":"NDC"}],"standard_charges":[{"minimum":780.69,"maximum":1203.45,"gross_charge":1473,"discounted_cash":337.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":780.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1203.45,"methodology":"fee schedule"}]}]},{"description":"ALTEPLASE 2MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0041-64","type":"NDC"}],"standard_charges":[{"minimum":72.96,"maximum":1203.45,"gross_charge":1473,"discounted_cash":337.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":216.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":295.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":295.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":164.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":780.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1203.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":100.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":101.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":103.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":102.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":100.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":100.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":100.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":102.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":100.35,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50MCG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6026-05","type":"NDC"}],"standard_charges":[{"minimum":46.11,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50MCG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00641-6026-05","type":"NDC"}],"standard_charges":[{"minimum":0.87,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50MCG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-9094-22","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50MCG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-9094-22","type":"NDC"}],"standard_charges":[{"minimum":0.87,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6MG INJ","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"70069-0804-05","type":"NDC"}],"standard_charges":[{"minimum":67.84,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6MG INJ","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0637","type":"RC"},{"code":"70069-0804-05","type":"NDC"}],"standard_charges":[{"minimum":50.23,"maximum":209.24,"gross_charge":128,"discounted_cash":29.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":156.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":156.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":66.05,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.23,"methodology":"fee schedule"}]}]},{"description":"TENECTEPLASE 50MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0120-47","type":"NDC"}],"standard_charges":[{"minimum":16424.17,"maximum":25318.02,"gross_charge":30989,"discounted_cash":7096.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16424.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25318.02,"methodology":"fee schedule"}]}]},{"description":"TENECTEPLASE 50MG INJ JW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0120-47","type":"NDC"}],"standard_charges":[{"minimum":125.55,"maximum":25318.02,"gross_charge":30989,"discounted_cash":7096.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":385.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":385.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":524.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":524.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":300.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":300.9,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16424.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25318.02,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":183.25,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":185.09,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":188.75,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":186.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":183.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":183.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":183.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":187.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":183.25,"methodology":"fee schedule"}]}]},{"description":"TERBUTALINE 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3105","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0665-01","type":"NDC"}],"standard_charges":[{"minimum":97.52,"maximum":150.33,"gross_charge":184,"discounted_cash":42.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":97.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"}]}]},{"description":"TERBUTALINE 1MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3105","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0665-01","type":"NDC"}],"standard_charges":[{"minimum":2.19,"maximum":150.33,"gross_charge":184,"discounted_cash":42.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":97.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.19,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2GM PWDR INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0412-01","type":"NDC"}],"standard_charges":[{"minimum":450.5,"maximum":694.45,"gross_charge":850,"discounted_cash":194.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":450.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":694.45,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2GM PWDR INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0412-01","type":"NDC"}],"standard_charges":[{"minimum":2.02,"maximum":694.45,"gross_charge":850,"discounted_cash":194.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":450.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":694.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0473-22","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0473-22","type":"NDC"}],"standard_charges":[{"minimum":2.02,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOL ACE 40MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00003-0293-05","type":"NDC"}],"standard_charges":[{"minimum":42.4,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOL ACE 40MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00003-0293-05","type":"NDC"}],"standard_charges":[{"minimum":0.92,"maximum":65.36,"gross_charge":80,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1273-32","type":"NDC"}],"standard_charges":[{"minimum":59.89,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1273-32","type":"NDC"}],"standard_charges":[{"minimum":8.76,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"}]}]},{"description":"VANCO 1.5GM/NS 500ML PMX","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0824-99","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"VANCO 1.5GM/NS 500ML PMX","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0824-99","type":"NDC"}],"standard_charges":[{"minimum":1.91,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0284-20","type":"NDC"}],"standard_charges":[{"minimum":86.39,"maximum":133.18,"gross_charge":163,"discounted_cash":37.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.18,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1GM INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0284-20","type":"NDC"}],"standard_charges":[{"minimum":1.91,"maximum":133.18,"gross_charge":163,"discounted_cash":37.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":86.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500MG(10GM)MDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0314-61","type":"NDC"}],"standard_charges":[{"minimum":57.77,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500MG(10GM)MDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0314-61","type":"NDC"}],"standard_charges":[{"minimum":1.91,"maximum":89.06,"gross_charge":109,"discounted_cash":24.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 750MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-6531-02","type":"NDC"}],"standard_charges":[{"minimum":50.35,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 750MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-6531-02","type":"NDC"}],"standard_charges":[{"minimum":1.91,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"VANCOMYC(MYL)500MG LYOSDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0339-50","type":"NDC"}],"standard_charges":[{"minimum":43.46,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"VANCOMYC(MYL)500MG LYOSDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0339-50","type":"NDC"}],"standard_charges":[{"minimum":14.96,"maximum":67,"gross_charge":82,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN(MYLAN)1.5GM LYOSDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0823-99","type":"NDC"}],"standard_charges":[{"minimum":109.18,"maximum":168.31,"gross_charge":206,"discounted_cash":47.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":168.31,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN(MYLAN)1.5GM LYOSDV","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0823-99","type":"NDC"}],"standard_charges":[{"minimum":14.96,"maximum":168.31,"gross_charge":206,"discounted_cash":47.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":168.31,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN(MYLAN)1.5GMLYOSDVJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0824-99","type":"NDC"}],"standard_charges":[{"minimum":130.91,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN(MYLAN)1.5GMLYOSDVJW","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0824-99","type":"NDC"}],"standard_charges":[{"minimum":14.96,"maximum":201.8,"gross_charge":247,"discounted_cash":56.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.8,"methodology":"fee schedule"}]}]},{"description":"VIT B1(THIAMINE)100MG/ML2ML IN","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0013-02","type":"NDC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"VIT B1(THIAMINE)100MG/ML2ML IN","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0013-02","type":"NDC"}],"standard_charges":[{"minimum":1.8,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"}]}]},{"description":"VIT B12 1000MCG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-0031-25","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"VIT B12 1000MCG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-0031-25","type":"NDC"}],"standard_charges":[{"minimum":1.3,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE 1MG/0.5ML PEDIM","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-9157-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE 1MG/0.5ML PEDIM","drug_information": {"unit": 0.5,"type": "ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-9157-01","type":"NDC"}],"standard_charges":[{"minimum":2.27,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"}]}]},{"description":"VIT K1(PHYTON)10MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-9158-01","type":"NDC"}],"standard_charges":[{"minimum":150.52,"maximum":232.03,"gross_charge":284,"discounted_cash":65.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":150.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.03,"methodology":"fee schedule"}]}]},{"description":"VIT K1(PHYTON)10MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-9158-01","type":"NDC"}],"standard_charges":[{"minimum":2.27,"maximum":232.03,"gross_charge":284,"discounted_cash":65.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":150.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.03,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00049-3190-28","type":"NDC"}],"standard_charges":[{"minimum":806.66,"maximum":1243.48,"gross_charge":1522,"discounted_cash":348.54,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":806.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1243.48,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00049-3190-28","type":"NDC"}],"standard_charges":[{"minimum":0.99,"maximum":1243.48,"gross_charge":1522,"discounted_cash":348.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":806.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1243.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"}]}]},{"description":"HYALURONIDASE 150U/ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00548-9090-10","type":"NDC"}],"standard_charges":[{"minimum":302.1,"maximum":465.69,"gross_charge":570,"discounted_cash":130.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.69,"methodology":"fee schedule"}]}]},{"description":"HYALURONIDASE 150U/ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00548-9090-10","type":"NDC"}],"standard_charges":[{"minimum":30.82,"maximum":465.69,"gross_charge":570,"discounted_cash":130.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":103.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":103.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.82,"methodology":"fee schedule"}]}]},{"description":"MAG SULF 1GM/2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-43","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"MAG SULF 1GM/2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-43","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"}]}]},{"description":"MAG SULF 1GM/D5W100ML PMX","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-6727-23","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"MAG SULF 1GM/D5W100ML PMX","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-6727-23","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"}]}]},{"description":"D5% 0.45 NACL+KCL 20MEQ 1L INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0671-04","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"D5% 0.45 NACL+KCL 20MEQ 1L INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0671-04","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"KCL 40MEQ 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-6653-05","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"KCL 40MEQ 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-6653-05","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"BACITRACIN 50000U INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0329-31","type":"NDC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"BACITRACIN 50000U INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0329-31","type":"NDC"}],"standard_charges":[{"minimum":12.88,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"BUPIV/EPI PF0.5%1:200K 50MLINJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0463-57","type":"NDC"}],"standard_charges":[{"minimum":71.55,"maximum":110.3,"gross_charge":135,"discounted_cash":30.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"}]}]},{"description":"BUPIV/EPI PF0.5%1:200K 50MLINJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0463-57","type":"NDC"}],"standard_charges":[{"minimum":18.9,"maximum":110.3,"gross_charge":135,"discounted_cash":30.92,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"}]}]},{"description":"BUPIVAC/EPI PF 0.5% 30ML INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0462-37","type":"NDC"}],"standard_charges":[{"minimum":45.05,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"}]}]},{"description":"BUPIVAC/EPI PF 0.5% 30ML INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0462-37","type":"NDC"}],"standard_charges":[{"minimum":11.9,"maximum":69.45,"gross_charge":85,"discounted_cash":19.47,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE/EPI 0.75% 30ML INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0460-37","type":"NDC"}],"standard_charges":[{"minimum":50.35,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE/EPI 0.75% 30ML INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0460-37","type":"NDC"}],"standard_charges":[{"minimum":13.3,"maximum":77.62,"gross_charge":95,"discounted_cash":21.76,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.62,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"}]}]},{"description":"CARBOPROST TROM 250MCG/1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0856-08","type":"NDC"}],"standard_charges":[{"minimum":810.9,"maximum":1250.01,"gross_charge":1530,"discounted_cash":350.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":810.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.01,"methodology":"fee schedule"}]}]},{"description":"CARBOPROST TROM 250MCG/1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00009-0856-08","type":"NDC"}],"standard_charges":[{"minimum":214.2,"maximum":1250.01,"gross_charge":1530,"discounted_cash":350.37,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":810.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"}]}]},{"description":"CISATRACURIUM 2MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9396-01","type":"NDC"}],"standard_charges":[{"minimum":32.33,"maximum":49.84,"gross_charge":61,"discounted_cash":13.97,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"}]}]},{"description":"CISATRACURIUM 2MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9396-01","type":"NDC"}],"standard_charges":[{"minimum":8.54,"maximum":49.84,"gross_charge":61,"discounted_cash":13.97,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.84,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"}]}]},{"description":"D25% 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1775-10","type":"NDC"}],"standard_charges":[{"minimum":37.63,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"}]}]},{"description":"D25% 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1775-10","type":"NDC"}],"standard_charges":[{"minimum":9.94,"maximum":58.01,"gross_charge":71,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"}]}]},{"description":"D50% PF 50ML SYR","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-4902-34","type":"NDC"}],"standard_charges":[{"minimum":62.54,"maximum":96.41,"gross_charge":118,"discounted_cash":27.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.41,"methodology":"fee schedule"}]}]},{"description":"D50% PF 50ML SYR","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-4902-34","type":"NDC"}],"standard_charges":[{"minimum":16.52,"maximum":96.41,"gross_charge":118,"discounted_cash":27.03,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.41,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"}]}]},{"description":"DANTROLENE 20MG PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"78670-0003-67","type":"NDC"}],"standard_charges":[{"minimum":378.42,"maximum":583.34,"gross_charge":714,"discounted_cash":163.51,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":378.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":583.34,"methodology":"fee schedule"}]}]},{"description":"DANTROLENE 20MG PWD INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"78670-0003-67","type":"NDC"}],"standard_charges":[{"minimum":99.96,"maximum":583.34,"gross_charge":714,"discounted_cash":163.51,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":378.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":583.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.96,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5MG/ML 25ML INJ","drug_information": {"unit": 25,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0427-10","type":"NDC"}],"standard_charges":[{"minimum":59.89,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5MG/ML 25ML INJ","drug_information": {"unit": 25,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0427-10","type":"NDC"}],"standard_charges":[{"minimum":15.82,"maximum":92.33,"gross_charge":113,"discounted_cash":25.88,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":59.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.33,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"}]}]},{"description":"ENALAPRILAT 1.25MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9787-10","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"ENALAPRILAT 1.25MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00143-9787-10","type":"NDC"}],"standard_charges":[{"minimum":7.56,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"}]}]},{"description":"EPHEDRINE 50MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70756-0611-25","type":"NDC"}],"standard_charges":[{"minimum":135.68,"maximum":209.16,"gross_charge":256,"discounted_cash":58.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.16,"methodology":"fee schedule"}]}]},{"description":"EPHEDRINE 50MG/ML 1ML INJ","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70756-0611-25","type":"NDC"}],"standard_charges":[{"minimum":35.84,"maximum":209.16,"gross_charge":256,"discounted_cash":58.63,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":135.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"}]}]},{"description":"ETOMIDATE 2MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0545-07","type":"NDC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"ETOMIDATE 2MG/ML 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0545-07","type":"NDC"}],"standard_charges":[{"minimum":9.52,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"}]}]},{"description":"ETOMIDATE 2MG/ML 20ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0509-10","type":"NDC"}],"standard_charges":[{"minimum":35.51,"maximum":54.74,"gross_charge":67,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"}]}]},{"description":"ETOMIDATE 2MG/ML 20ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0509-10","type":"NDC"}],"standard_charges":[{"minimum":9.38,"maximum":54.74,"gross_charge":67,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"}]}]},{"description":"FAT EMULSION 20% 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0519-09","type":"NDC"}],"standard_charges":[{"minimum":242.21,"maximum":373.37,"gross_charge":457,"discounted_cash":104.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":242.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.37,"methodology":"fee schedule"}]}]},{"description":"FAT EMULSION 20% 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0519-09","type":"NDC"}],"standard_charges":[{"minimum":63.98,"maximum":373.37,"gross_charge":457,"discounted_cash":104.66,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":242.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.98,"methodology":"fee schedule"}]}]},{"description":"FAT EMULSION(CLIN)20% 250ML IN","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-9540-06","type":"NDC"}],"standard_charges":[{"minimum":238.5,"maximum":367.65,"gross_charge":450,"discounted_cash":103.05,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":238.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":367.65,"methodology":"fee schedule"}]}]},{"description":"FAT EMULSION(CLIN)20% 250ML IN","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-9540-06","type":"NDC"}],"standard_charges":[{"minimum":63,"maximum":367.65,"gross_charge":450,"discounted_cash":103.05,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":238.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":367.65,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"}]}]},{"description":"FAT EMULSIONS 20% 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0519-04","type":"NDC"}],"standard_charges":[{"minimum":361.46,"maximum":557.2,"gross_charge":682,"discounted_cash":156.18,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":361.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":557.2,"methodology":"fee schedule"}]}]},{"description":"FAT EMULSIONS 20% 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0519-04","type":"NDC"}],"standard_charges":[{"minimum":95.48,"maximum":557.2,"gross_charge":682,"discounted_cash":156.18,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":361.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":557.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.48,"methodology":"fee schedule"}]}]},{"description":"FLUMAZENIL 0.1MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0424-05","type":"NDC"}],"standard_charges":[{"minimum":37.1,"maximum":57.19,"gross_charge":70,"discounted_cash":16.03,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"}]}]},{"description":"FLUMAZENIL 0.1MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0424-05","type":"NDC"}],"standard_charges":[{"minimum":9.8,"maximum":57.19,"gross_charge":70,"discounted_cash":16.03,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.19,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"}]}]},{"description":"INDOCYANINE GREEN 25MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66259-0903-24","type":"NDC"}],"standard_charges":[{"minimum":477.53,"maximum":736.12,"gross_charge":901,"discounted_cash":206.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":477.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":736.12,"methodology":"fee schedule"}]}]},{"description":"INDOCYANINE GREEN 25MG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66259-0903-24","type":"NDC"}],"standard_charges":[{"minimum":126.14,"maximum":736.12,"gross_charge":901,"discounted_cash":206.33,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":477.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":736.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.14,"methodology":"fee schedule"}]}]},{"description":"K PHOS 3MMOL/ML 15ML SDV","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-1691-02","type":"NDC"}],"standard_charges":[{"minimum":243.27,"maximum":375.01,"gross_charge":459,"discounted_cash":105.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":243.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":375.01,"methodology":"fee schedule"}]}]},{"description":"K PHOS 3MMOL/ML 15ML SDV","drug_information": {"unit": 15,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-1691-02","type":"NDC"}],"standard_charges":[{"minimum":64.26,"maximum":375.01,"gross_charge":459,"discounted_cash":105.12,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":243.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":375.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"}]}]},{"description":"KETAMINE 10MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0113-10","type":"NDC"}],"standard_charges":[{"minimum":81.09,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"}]}]},{"description":"KETAMINE 10MG/ML 20ML INJ","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0113-10","type":"NDC"}],"standard_charges":[{"minimum":21.42,"maximum":125.01,"gross_charge":153,"discounted_cash":35.04,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"}]}]},{"description":"LEVOCARNITINE 1GM/5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54482-0147-01","type":"NDC"}],"standard_charges":[{"minimum":173.31,"maximum":267.16,"gross_charge":327,"discounted_cash":74.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":173.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":267.16,"methodology":"fee schedule"}]}]},{"description":"LEVOCARNITINE 1GM/5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54482-0147-01","type":"NDC"}],"standard_charges":[{"minimum":45.78,"maximum":267.16,"gross_charge":327,"discounted_cash":74.89,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":173.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":267.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.78,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100MCG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0468-10","type":"NDC"}],"standard_charges":[{"minimum":510.92,"maximum":787.59,"gross_charge":964,"discounted_cash":220.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":510.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":787.59,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100MCG INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0468-10","type":"NDC"}],"standard_charges":[{"minimum":134.96,"maximum":787.59,"gross_charge":964,"discounted_cash":220.76,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":510.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":787.59,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.96,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 20% 500ML PB","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7578-10","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 20% 500ML PB","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7578-10","type":"NDC"}],"standard_charges":[{"minimum":49,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"MULTIVIT W VIT K 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54643-7862-01","type":"NDC"}],"standard_charges":[{"minimum":55.12,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"}]}]},{"description":"MULTIVIT W VIT K 10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54643-7862-01","type":"NDC"}],"standard_charges":[{"minimum":14.56,"maximum":84.97,"gross_charge":104,"discounted_cash":23.82,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":55.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"}]}]},{"description":"NA BICARB 0.48MEQ/ML 5MLINJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0083-05","type":"NDC"}],"standard_charges":[{"minimum":127.73,"maximum":196.9,"gross_charge":241,"discounted_cash":55.19,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.9,"methodology":"fee schedule"}]}]},{"description":"NA BICARB 0.48MEQ/ML 5MLINJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0083-05","type":"NDC"}],"standard_charges":[{"minimum":33.74,"maximum":196.9,"gross_charge":241,"discounted_cash":55.19,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.74,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.74,"methodology":"fee schedule"}]}]},{"description":"NA BICARB 4.2% 5MEQ/10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-5012-04","type":"NDC"}],"standard_charges":[{"minimum":40.28,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"}]}]},{"description":"NA BICARB 4.2% 5MEQ/10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-5012-04","type":"NDC"}],"standard_charges":[{"minimum":10.64,"maximum":62.1,"gross_charge":76,"discounted_cash":17.41,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"}]}]},{"description":"NA BICARB 8.4% 50MEQ/50ML INJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-5001-04","type":"NDC"}],"standard_charges":[{"minimum":47.7,"maximum":73.53,"gross_charge":90,"discounted_cash":20.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.53,"methodology":"fee schedule"}]}]},{"description":"NA BICARB 8.4% 50MEQ/50ML INJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-5001-04","type":"NDC"}],"standard_charges":[{"minimum":12.6,"maximum":73.53,"gross_charge":90,"discounted_cash":20.61,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"NA BICARB 8.4% 50MEQ/50ML SYR","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0214-50","type":"NDC"}],"standard_charges":[{"minimum":54.06,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"}]}]},{"description":"NA BICARB 8.4% 50MEQ/50ML SYR","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0214-50","type":"NDC"}],"standard_charges":[{"minimum":14.28,"maximum":83.34,"gross_charge":102,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"}]}]},{"description":"NA TETRADECYL 3% 60MG/2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0163-02","type":"NDC"}],"standard_charges":[{"minimum":338.14,"maximum":521.25,"gross_charge":638,"discounted_cash":146.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":338.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":521.25,"methodology":"fee schedule"}]}]},{"description":"NA TETRADECYL 3% 60MG/2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0163-02","type":"NDC"}],"standard_charges":[{"minimum":89.32,"maximum":521.25,"gross_charge":638,"discounted_cash":146.11,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":338.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":521.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.32,"methodology":"fee schedule"}]}]},{"description":"NITROPRUSSIDE 50MG/2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42998-0302-02","type":"NDC"}],"standard_charges":[{"minimum":729.28,"maximum":1124.2,"gross_charge":1376,"discounted_cash":315.11,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":729.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1124.2,"methodology":"fee schedule"}]}]},{"description":"NITROPRUSSIDE 50MG/2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42998-0302-02","type":"NDC"}],"standard_charges":[{"minimum":192.64,"maximum":1124.2,"gross_charge":1376,"discounted_cash":315.11,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":729.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1124.2,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.64,"methodology":"fee schedule"}]}]},{"description":"NOREPINEPH 8MG/NS 250ML PMX","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81298-9655-03","type":"NDC"}],"standard_charges":[{"minimum":205.64,"maximum":317,"gross_charge":388,"discounted_cash":88.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":205.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317,"methodology":"fee schedule"}]}]},{"description":"NOREPINEPH 8MG/NS 250ML PMX","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81298-9655-03","type":"NDC"}],"standard_charges":[{"minimum":54.32,"maximum":317,"gross_charge":388,"discounted_cash":88.86,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":205.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"}]}]},{"description":"POLYMYXIN B 500000U INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0249-10","type":"NDC"}],"standard_charges":[{"minimum":51.94,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"}]}]},{"description":"POLYMYXIN B 500000U INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0249-10","type":"NDC"}],"standard_charges":[{"minimum":13.72,"maximum":80.07,"gross_charge":98,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE 5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3040-95","type":"NDC"}],"standard_charges":[{"minimum":158.47,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE 5MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00781-3040-95","type":"NDC"}],"standard_charges":[{"minimum":41.86,"maximum":244.29,"gross_charge":299,"discounted_cash":68.48,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":158.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.86,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.86,"methodology":"fee schedule"}]}]},{"description":"SUFENTANIL 50MCG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"11098-0050-02","type":"NDC"}],"standard_charges":[{"minimum":41.34,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"}]}]},{"description":"SUFENTANIL 50MCG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"11098-0050-02","type":"NDC"}],"standard_charges":[{"minimum":10.92,"maximum":63.73,"gross_charge":78,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.73,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"}]}]},{"description":"SUGAMMADEX 100MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00006-5423-12","type":"NDC"}],"standard_charges":[{"minimum":648.72,"maximum":1000.01,"gross_charge":1224,"discounted_cash":280.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":648.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1000.01,"methodology":"fee schedule"}]}]},{"description":"SUGAMMADEX 100MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00006-5423-12","type":"NDC"}],"standard_charges":[{"minimum":171.36,"maximum":1000.01,"gross_charge":1224,"discounted_cash":280.3,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":648.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1000.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.36,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.36,"methodology":"fee schedule"}]}]},{"description":"THROMBIN 5000U PWDR","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60793-0215-05","type":"NDC"}],"standard_charges":[{"minimum":352.98,"maximum":544.13,"gross_charge":666,"discounted_cash":152.52,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":352.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":544.13,"methodology":"fee schedule"}]}]},{"description":"THROMBIN 5000U PWDR","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60793-0215-05","type":"NDC"}],"standard_charges":[{"minimum":93.24,"maximum":544.13,"gross_charge":666,"discounted_cash":152.52,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":352.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":544.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.24,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.24,"methodology":"fee schedule"}]}]},{"description":"TPN CLINIMIX 4.25/10% 2L INJ","drug_information": {"unit": 2000,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1091-04","type":"NDC"}],"standard_charges":[{"minimum":694.3,"maximum":1070.27,"gross_charge":1310,"discounted_cash":299.99,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":694.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1070.27,"methodology":"fee schedule"}]}]},{"description":"TPN CLINIMIX 4.25/10% 2L INJ","drug_information": {"unit": 2000,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1091-04","type":"NDC"}],"standard_charges":[{"minimum":183.4,"maximum":1070.27,"gross_charge":1310,"discounted_cash":299.99,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":694.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1070.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.4,"methodology":"fee schedule"}]}]},{"description":"TPN CLINIMIX E 5/15 2L INJ","drug_information": {"unit": 2000,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1123-04","type":"NDC"}],"standard_charges":[{"minimum":367.82,"maximum":567,"gross_charge":694,"discounted_cash":158.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":367.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"TPN CLINIMIX E 5/15 2L INJ","drug_information": {"unit": 2000,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-1123-04","type":"NDC"}],"standard_charges":[{"minimum":97.16,"maximum":567,"gross_charge":694,"discounted_cash":158.93,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":367.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.16,"methodology":"fee schedule"}]}]},{"description":"VALPROIC ACID 100MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0494-05","type":"NDC"}],"standard_charges":[{"minimum":38.16,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"VALPROIC ACID 100MG/ML 5ML INJ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0494-05","type":"NDC"}],"standard_charges":[{"minimum":10.08,"maximum":58.83,"gross_charge":72,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"}]}]},{"description":"VECURONIUM 10MG LYOPH SDV","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47335-0931-44","type":"NDC"}],"standard_charges":[{"minimum":46.11,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"}]}]},{"description":"VECURONIUM 10MG LYOPH SDV","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47335-0931-44","type":"NDC"}],"standard_charges":[{"minimum":12.18,"maximum":71.08,"gross_charge":87,"discounted_cash":19.93,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"}]}]},{"description":"VERAPAMIL 5MG/2ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-0203-02","type":"NDC"}],"standard_charges":[{"minimum":173.84,"maximum":267.98,"gross_charge":328,"discounted_cash":75.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":173.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":267.98,"methodology":"fee schedule"}]}]},{"description":"VERAPAMIL 5MG/2ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-0203-02","type":"NDC"}],"standard_charges":[{"minimum":45.92,"maximum":267.98,"gross_charge":328,"discounted_cash":75.12,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":173.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":267.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"}]}]},{"description":"VERAPAMIL 5MG/2ML 4ML INJ","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1144-02","type":"NDC"}],"standard_charges":[{"minimum":43.99,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"}]}]},{"description":"VERAPAMIL 5MG/2ML 4ML INJ","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00409-1144-02","type":"NDC"}],"standard_charges":[{"minimum":11.62,"maximum":67.82,"gross_charge":83,"discounted_cash":19.01,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0049-04","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0049-04","type":"NDC"}],"standard_charges":[{"minimum":2.56,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 500ML INJ","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0049-03","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 500ML INJ","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0049-03","type":"NDC"}],"standard_charges":[{"minimum":1.28,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"}]}]},{"description":"D5% 0.9 NACL 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J7042","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7610-00","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"D5% 0.9 NACL 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J7042","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7610-00","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0049-02","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"NACL 0.9% 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0049-02","type":"NDC"}],"standard_charges":[{"minimum":0.65,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"}]}]},{"description":"D5% 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7510-20","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"D5% 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7510-20","type":"NDC"}],"standard_charges":[{"minimum":1.85,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"}]}]},{"description":"D5% 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7510-00","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"D5% 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7510-00","type":"NDC"}],"standard_charges":[{"minimum":3.69,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"}]}]},{"description":"LACTATED RINGERS 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0117-04","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"LACTATED RINGERS 1000ML INJ","drug_information": {"unit": 1000,"type": "ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00338-0117-04","type":"NDC"}],"standard_charges":[{"minimum":2.47,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"}]}]},{"description":"NACL 23.4% 30ML CONC INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0187-30","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"NACL 23.4% 30ML CONC INJ","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0187-30","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"NACL 3% 4ML NEB","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50190-0142-63","type":"NDC"}],"standard_charges":[{"minimum":3.71,"maximum":5.72,"gross_charge":7,"discounted_cash":1.61,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"}]}]},{"description":"NACL 3% 4ML NEB","drug_information": {"unit": 4,"type": "ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50190-0142-63","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":5.72,"gross_charge":7,"discounted_cash":1.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"NACL 3% 500ML INJ","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7805-10","type":"NDC"}],"standard_charges":[{"minimum":185.5,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"}]}]},{"description":"NACL 3% 500ML INJ","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00264-7805-10","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":285.95,"gross_charge":350,"discounted_cash":80.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":185.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"KCENTRA (500IU) 1IU INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0386-02","type":"NDC"}],"standard_charges":[{"minimum":16.43,"maximum":25.33,"gross_charge":31,"discounted_cash":7.1,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"}]}]},{"description":"KCENTRA (500IU) 1IU INJ","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0386-02","type":"NDC"}],"standard_charges":[{"minimum":5.3,"maximum":25.33,"gross_charge":31,"discounted_cash":7.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"}]}]},{"description":"FACT 8(ALPHANATE)1IU(500IU)VL","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7186","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-4617-01","type":"NDC"}],"standard_charges":[{"minimum":1.22,"maximum":9.81,"gross_charge":12,"discounted_cash":2.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"}]}]},{"description":"FACT 8(ALPHANATE)1IU(500IU)VL","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7186","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-4617-01","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":9.81,"gross_charge":12,"discounted_cash":2.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 0.5MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00469-0607-73","type":"NDC"}],"standard_charges":[{"minimum":12.19,"maximum":18.8,"gross_charge":23,"discounted_cash":5.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 0.5MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00469-0607-73","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":18.8,"gross_charge":23,"discounted_cash":5.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0761-01","type":"NDC"}],"standard_charges":[{"minimum":2.65,"maximum":4.09,"gross_charge":5,"discounted_cash":1.15,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0761-01","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":4.09,"gross_charge":5,"discounted_cash":1.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"METHYLPRED 4MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00904-6914-61","type":"NDC"}],"standard_charges":[{"minimum":10.07,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"METHYLPRED 4MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00904-6914-61","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"PREDNISOL 15MG/5ML 5ML LIQ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10020-7100-00","type":"NDC"}],"standard_charges":[{"minimum":7.42,"maximum":11.44,"gross_charge":14,"discounted_cash":3.21,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"}]}]},{"description":"PREDNISOL 15MG/5ML 5ML LIQ","drug_information": {"unit": 5,"type": "ML"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10020-7100-00","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":11.44,"gross_charge":14,"discounted_cash":3.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00054-8724-25","type":"NDC"}],"standard_charges":[{"minimum":2.12,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00054-8724-25","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.01,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE 250MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00004-0259-01","type":"NDC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE 250MG CAP","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00004-0259-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE ER 180MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00078-0385-66","type":"NDC"}],"standard_charges":[{"minimum":20.14,"maximum":31.05,"gross_charge":38,"discounted_cash":8.71,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE ER 180MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00078-0385-66","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":31.05,"gross_charge":38,"discounted_cash":8.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"}]}]},{"description":"NITROPRUSSIDE 50MG/2ML PEDIV","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00703-1802-01","type":"NDC"}],"standard_charges":[{"minimum":28.62,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"NITROPRUSSIDE 50MG/2ML PEDIV","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00703-1802-01","type":"NDC"}],"standard_charges":[{"minimum":7.56,"maximum":44.12,"gross_charge":54,"discounted_cash":12.37,"setting":"outpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 1MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00054-8174-25","type":"NDC"}],"standard_charges":[{"minimum":2.12,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 1MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00054-8174-25","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":3.27,"gross_charge":4,"discounted_cash":0.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00054-8175-25","type":"NDC"}],"standard_charges":[{"minimum":3.18,"maximum":4.91,"gross_charge":6,"discounted_cash":1.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00054-8175-25","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":4.91,"gross_charge":6,"discounted_cash":1.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE 2.5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00054-4550-25","type":"NDC"}],"standard_charges":[{"minimum":33.39,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE 2.5MG TAB","drug_information": {"unit": 1,"type": "UN"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00054-4550-25","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":51.48,"gross_charge":63,"discounted_cash":14.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE 25MG/ML 2ML SDV","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0350-38","type":"NDC"}],"standard_charges":[{"minimum":47.17,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE 25MG/ML 2ML SDV","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0350-38","type":"NDC"}],"standard_charges":[{"minimum":3.45,"maximum":72.72,"gross_charge":89,"discounted_cash":20.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"}]}]},{"description":"ORTHO L0625 <10","code_information":[{"code":"L0625","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":8.48,"maximum":13.08,"gross_charge":16,"discounted_cash":3.67,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"}]}]},{"description":"ORTHO L0625 <10","code_information":[{"code":"L0625","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":2.47,"maximum":71.13,"gross_charge":16,"discounted_cash":3.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.47,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":53.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":53.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"}]}]},{"description":"ORTHO L1830 <10","code_information":[{"code":"L1830","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":10.07,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"ORTHO L1830 <10","code_information":[{"code":"L1830","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":2.93,"maximum":86.83,"gross_charge":19,"discounted_cash":4.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"}]}]},{"description":"ORTHO L1830 10-13","code_information":[{"code":"L1830","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":17.98,"gross_charge":22,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"ORTHO L1830 10-13","code_information":[{"code":"L1830","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":3.39,"maximum":86.83,"gross_charge":22,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"}]}]},{"description":"ORTHO L1830 13X-17","code_information":[{"code":"L1830","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":15.37,"maximum":23.7,"gross_charge":29,"discounted_cash":6.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"}]}]},{"description":"ORTHO L1830 13X-17","code_information":[{"code":"L1830","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":4.47,"maximum":86.83,"gross_charge":29,"discounted_cash":6.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.47,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":59.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":59.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"}]}]},{"description":"ORTHO L3260 <10","code_information":[{"code":"L3260","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":10.07,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"ORTHO L3260 <10","code_information":[{"code":"L3260","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":2.66,"maximum":52.19,"gross_charge":19,"discounted_cash":4.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.19,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"}]}]},{"description":"ORTHO L3650 <10","code_information":[{"code":"L3650","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":10.07,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"ORTHO L3650 <10","code_information":[{"code":"L3650","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":2.93,"maximum":113.12,"gross_charge":19,"discounted_cash":4.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.12,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":84.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":84.85,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.61,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.61,"methodology":"fee schedule"}]}]},{"description":"ORTHO L3908 <10","code_information":[{"code":"L3908","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":10.07,"maximum":15.53,"gross_charge":19,"discounted_cash":4.36,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"ORTHO L3908 <10","code_information":[{"code":"L3908","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":2.93,"maximum":96.71,"gross_charge":19,"discounted_cash":4.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.19,"methodology":"fee schedule"}]}]},{"description":"ORTHO L3908 10-13","code_information":[{"code":"L3908","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":17.98,"gross_charge":22,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"ORTHO L3908 10-13","code_information":[{"code":"L3908","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":3.39,"maximum":96.71,"gross_charge":22,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.39,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.39,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.71,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":72.54,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":72.54,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.19,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.19,"methodology":"fee schedule"}]}]},{"description":"ORTHO L4350 13X-17","code_information":[{"code":"L4350","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":15.37,"maximum":23.7,"gross_charge":29,"discounted_cash":6.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"}]}]},{"description":"ORTHO L4350 13X-17","code_information":[{"code":"L4350","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":4.47,"maximum":174.21,"gross_charge":29,"discounted_cash":6.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.47,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.47,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":130.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":130.68,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.72,"methodology":"fee schedule"}]}]},{"description":"ORTHO L4360 23X-30","code_information":[{"code":"L4360","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":27.03,"maximum":41.67,"gross_charge":51,"discounted_cash":11.68,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"}]}]},{"description":"ORTHO L4360 23X-30","code_information":[{"code":"L4360","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":7.86,"maximum":252.97,"gross_charge":51,"discounted_cash":11.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.86,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.86,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":189.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":189.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.47,"methodology":"fee schedule"}]}]},{"description":"ORTHO L4360 30X-39","code_information":[{"code":"L4360","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":34.98,"maximum":53.93,"gross_charge":66,"discounted_cash":15.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"}]}]},{"description":"ORTHO L4360 30X-39","code_information":[{"code":"L4360","type":"HCPCS"},{"code":"0274","type":"RC"}],"standard_charges":[{"minimum":10.17,"maximum":252.97,"gross_charge":66,"discounted_cash":15.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.17,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252.97,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":189.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":189.76,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.47,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.47,"methodology":"fee schedule"}]}]},{"description":"PROSTHETIC IMP NOS 10-13","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":48.76,"maximum":75.17,"gross_charge":92,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"}]}]},{"description":"PROSTHETIC IMP NOS 10-13","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":1059.67,"gross_charge":92,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.17,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.17,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":19.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"PROSTHETIC IMP NOS 1605X-2087","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4104.32,"maximum":6326.85,"gross_charge":7744,"discounted_cash":1773.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4104.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6326.85,"methodology":"fee schedule"}]}]},{"description":"PROSTHETIC IMP NOS 1605X-2087","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":6326.85,"gross_charge":7744,"discounted_cash":1773.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1192.58,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1192.58,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1680.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1680.45,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4104.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6326.85,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.16,"methodology":"fee schedule"}]}]},{"description":"PROSTHETIC IMP NOS 2087X-2714","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4659.76,"maximum":7183.07,"gross_charge":8792,"discounted_cash":2013.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4659.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7183.07,"methodology":"fee schedule"}]}]},{"description":"PROSTHETIC IMP NOS 2087X-2714","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":7183.07,"gross_charge":8792,"discounted_cash":2013.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.97,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1353.97,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1907.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1907.87,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4659.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7183.07,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1230.88,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1230.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1230.88,"methodology":"fee schedule"}]}]},{"description":"TRANSPROST IMP 431X-561","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4346,"maximum":6699.4,"gross_charge":8200,"discounted_cash":1877.8,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4346,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6699.4,"methodology":"fee schedule"}]}]},{"description":"TRANSPROST IMP 431X-561","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":794.88,"maximum":6699.4,"gross_charge":8200,"discounted_cash":1877.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1262.8,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1262.8,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1779.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1779.4,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4346,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6699.4,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":1148,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":1148,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":1148,"methodology":"fee schedule"}]}]},{"description":"TRANSPROST IMP 949X-1234","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2337.3,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"}]}]},{"description":"TRANSPROST IMP 949X-1234","code_information":[{"code":"L8699","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":617.4,"maximum":3602.97,"gross_charge":4410,"discounted_cash":1009.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.14,"methodology":"case rate"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.67,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":794.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":956.97,"methodology":"case rate"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2337.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3602.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.4,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"Other Inpatient","type":"LOCAL"}],"standard_charges":[{"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"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":"Other Outpatient","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":36.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":36.7,"count":"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":37.9,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_percentage":37.9,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":81.7,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"WHOLE BLOOD EACH UNIT","code_information":[{"code":"P9010","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":563.39,"maximum":868.48,"gross_charge":1063,"discounted_cash":243.43,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":563.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":868.48,"methodology":"fee schedule"}]}]},{"description":"WHOLE BLOOD EACH UNIT","code_information":[{"code":"P9010","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":111.57,"maximum":868.48,"gross_charge":1063,"discounted_cash":243.43,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":266.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":266.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":563.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":868.48,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":239.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":242.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":247.14,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":244.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":239.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":239.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":239.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":245.94,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":239.94,"methodology":"fee schedule"}]}]},{"description":"PLATELETS SPLIT UN SPECIFY AMT","code_information":[{"code":"P9011","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":766.38,"maximum":1181.39,"gross_charge":1446,"discounted_cash":331.14,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":766.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1181.39,"methodology":"fee schedule"}]}]},{"description":"PLATELETS SPLIT UN SPECIFY AMT","code_information":[{"code":"P9011","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":50.42,"maximum":1181.39,"gross_charge":1446,"discounted_cash":331.14,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":766.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1181.39,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":152.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":155.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":154.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":154.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"}]}]},{"description":"RBC SPLIT UNIT SPECIFY AMT","code_information":[{"code":"P9011","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":337.61,"maximum":520.43,"gross_charge":637,"discounted_cash":145.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":337.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":520.43,"methodology":"fee schedule"}]}]},{"description":"RBC SPLIT UNIT SPECIFY AMT","code_information":[{"code":"P9011","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":50.42,"maximum":520.43,"gross_charge":637,"discounted_cash":145.88,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":337.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":520.43,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.68,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":152.65,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":155.67,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":154.16,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":154.91,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":151.13,"methodology":"fee schedule"}]}]},{"description":"CRYOPRECIPITATE EA UNIT","code_information":[{"code":"P9012","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":17.98,"gross_charge":22,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"CRYOPRECIPITATE EA UNIT","code_information":[{"code":"P9012","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":11.66,"maximum":355.86,"gross_charge":22,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":266.94,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":266.94,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.58,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":22.22,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":22.66,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"}]}]},{"description":"RBC LEUKO REDUCED EA UNIT","code_information":[{"code":"P9016","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":509.86,"maximum":785.96,"gross_charge":962,"discounted_cash":220.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":509.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":785.96,"methodology":"fee schedule"}]}]},{"description":"RBC LEUKO REDUCED EA UNIT","code_information":[{"code":"P9016","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":74.01,"maximum":785.96,"gross_charge":962,"discounted_cash":220.3,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":533.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":400.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":400.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":509.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":785.96,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.01,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":193.98,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":195.92,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":199.8,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":197.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":193.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":193.98,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":193.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":198.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":193.98,"methodology":"fee schedule"}]}]},{"description":"FRESH FROZEN PLASMA EA UNIT","code_information":[{"code":"P9017","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":220.48,"maximum":339.88,"gross_charge":416,"discounted_cash":95.27,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":220.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":339.88,"methodology":"fee schedule"}]}]},{"description":"FRESH FROZEN PLASMA EA UNIT","code_information":[{"code":"P9017","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":34.8,"maximum":339.88,"gross_charge":416,"discounted_cash":95.27,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":220.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":339.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":89.84,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":92.54,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":91.64,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":89.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":89.84,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":89.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":92.09,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":89.84,"methodology":"fee schedule"}]}]},{"description":"PLATELETS EACH UNIT","code_information":[{"code":"P9019","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":95.4,"maximum":147.06,"gross_charge":180,"discounted_cash":41.22,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"}]}]},{"description":"PLATELETS EACH UNIT","code_information":[{"code":"P9019","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":34.8,"maximum":205.6,"gross_charge":180,"discounted_cash":41.22,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":83.39,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":82.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":82.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":80.96,"methodology":"fee schedule"}]}]},{"description":"RBC EACH UNIT AUTOLOGOUS","code_information":[{"code":"P9021","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":525.76,"maximum":810.47,"gross_charge":992,"discounted_cash":227.17,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":525.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":810.47,"methodology":"fee schedule"}]}]},{"description":"RBC EACH UNIT AUTOLOGOUS","code_information":[{"code":"P9021","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":52.25,"maximum":810.47,"gross_charge":992,"discounted_cash":227.17,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":243.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":243.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":525.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":810.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":155.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":158.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":156.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":157.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"}]}]},{"description":"RBC PACKED EACH UNIT","code_information":[{"code":"P9021","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":389.02,"maximum":599.68,"gross_charge":734,"discounted_cash":168.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":389.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":599.68,"methodology":"fee schedule"}]}]},{"description":"RBC PACKED EACH UNIT","code_information":[{"code":"P9021","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":52.25,"maximum":599.68,"gross_charge":734,"discounted_cash":168.09,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":243.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":243.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":389.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":599.68,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":155.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":158.44,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":156.9,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":157.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":153.82,"methodology":"fee schedule"}]}]},{"description":"PLATELETS LEUKO REDUCE EA UNIT","code_information":[{"code":"P9031","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":365.17,"maximum":562.92,"gross_charge":689,"discounted_cash":157.79,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":365.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":562.92,"methodology":"fee schedule"}]}]},{"description":"PLATELETS LEUKO REDUCE EA UNIT","code_information":[{"code":"P9031","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":111.41,"maximum":562.92,"gross_charge":689,"discounted_cash":157.79,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":365.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":562.92,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.41,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":134.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":135.4,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":138.08,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":136.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":134.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":134.05,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":134.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":137.41,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":134.05,"methodology":"fee schedule"}]}]},{"description":"PLATELETS PHERESIS EA UNIT","code_information":[{"code":"P9034","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":1281.01,"maximum":1974.69,"gross_charge":2417,"discounted_cash":553.5,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1281.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1974.69,"methodology":"fee schedule"}]}]},{"description":"PLATELETS PHERESIS EA UNIT","code_information":[{"code":"P9034","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":240.76,"maximum":2649.18,"gross_charge":2417,"discounted_cash":553.5,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2649.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1987.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1987.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1281.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1974.69,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.76,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":423.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":427.51,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":435.97,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":431.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":423.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":423.27,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":423.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":433.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":423.27,"methodology":"fee schedule"}]}]},{"description":"PLATELETS PHER LR EA UNIT","code_information":[{"code":"P9035","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":1399.2,"maximum":2156.88,"gross_charge":2640,"discounted_cash":604.56,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1399.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2156.88,"methodology":"fee schedule"}]}]},{"description":"PLATELETS PHER LR EA UNIT","code_information":[{"code":"P9035","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":361.75,"maximum":2649.18,"gross_charge":2640,"discounted_cash":604.56,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2649.18,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":1987.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":1987.22,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1399.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2156.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":519.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":524.36,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":534.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":529.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":519.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":519.16,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":519.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":532.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":519.16,"methodology":"fee schedule"}]}]},{"description":"PLATELETS PHER IRR EA UNIT","code_information":[{"code":"P9036","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":2149.15,"maximum":3312.94,"gross_charge":4055,"discounted_cash":928.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2149.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3312.94,"methodology":"fee schedule"}]}]},{"description":"PLATELETS PHER IRR EA UNIT","code_information":[{"code":"P9036","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":449.51,"maximum":3312.94,"gross_charge":4055,"discounted_cash":928.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2846.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2135.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2135.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2149.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3312.94,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.51,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":626.33,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":632.6,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":645.12,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":638.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":626.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":626.33,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":626.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":641.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":626.33,"methodology":"fee schedule"}]}]},{"description":"PLATELETS PHER LR IRR EA UNIT","code_information":[{"code":"P9037","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":1848.64,"maximum":2849.7,"gross_charge":3488,"discounted_cash":798.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1848.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2849.7,"methodology":"fee schedule"}]}]},{"description":"PLATELETS PHER LR IRR EA UNIT","code_information":[{"code":"P9037","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":458.75,"maximum":2849.7,"gross_charge":3488,"discounted_cash":798.76,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2846.88,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2135.52,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2135.52,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1848.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2849.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":458.75,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":458.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":458.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":720.13,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":727.34,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":741.74,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":734.54,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":720.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":720.13,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":720.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":738.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":720.13,"methodology":"fee schedule"}]}]},{"description":"RBC IRRADIATED EA UNIT DIR","code_information":[{"code":"P9038","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":616.39,"maximum":950.18,"gross_charge":1163,"discounted_cash":266.33,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":616.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":950.18,"methodology":"fee schedule"}]}]},{"description":"RBC IRRADIATED EA UNIT DIR","code_information":[{"code":"P9038","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":125.82,"maximum":950.18,"gross_charge":1163,"discounted_cash":266.33,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":243.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":243.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":616.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":950.18,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":159.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":160.64,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":163.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":162.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":159.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":159.04,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":159.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":163.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":159.04,"methodology":"fee schedule"}]}]},{"description":"RBC LR IRR EA UNIT","code_information":[{"code":"P9040","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":669.39,"maximum":1031.88,"gross_charge":1263,"discounted_cash":289.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":669.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1031.88,"methodology":"fee schedule"}]}]},{"description":"RBC LR IRR EA UNIT","code_information":[{"code":"P9040","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":193.62,"maximum":1031.88,"gross_charge":1263,"discounted_cash":289.23,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.22,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":243.21,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":243.21,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":669.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1031.88,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.62,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.62,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":272.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":275.37,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":280.82,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":278.1,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":272.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":272.64,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":272.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":279.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":272.64,"methodology":"fee schedule"}]}]},{"description":"PLASMA CRYO REDUCED EA UNIT","code_information":[{"code":"P9044","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":258.64,"maximum":398.7,"gross_charge":488,"discounted_cash":111.76,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":258.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":398.7,"methodology":"fee schedule"}]}]},{"description":"PLASMA CRYO REDUCED EA UNIT","code_information":[{"code":"P9044","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":48.82,"maximum":439.24,"gross_charge":488,"discounted_cash":111.76,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":329.49,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":329.49,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":258.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":398.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":157,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":158.57,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":161.71,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":160.14,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":157,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":157,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":157,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":157,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN 5% 12.5GM 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"P9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5218-04","type":"NDC"}],"standard_charges":[{"minimum":249.1,"maximum":383.99,"gross_charge":470,"discounted_cash":107.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":249.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.99,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN 5% 12.5GM 250ML INJ","drug_information": {"unit": 250,"type": "ML"},"code_information":[{"code":"P9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5218-04","type":"NDC"}],"standard_charges":[{"minimum":43.52,"maximum":383.99,"gross_charge":470,"discounted_cash":107.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":83.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":249.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":57.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":57.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN 5% 25GM 500ML INJ JW","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"P9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5219-02","type":"NDC"}],"standard_charges":[{"minimum":497.67,"maximum":767.17,"gross_charge":939,"discounted_cash":215.04,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":497.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":767.17,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN 5% 25GM 500ML INJ JW","drug_information": {"unit": 500,"type": "ML"},"code_information":[{"code":"P9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5219-02","type":"NDC"}],"standard_charges":[{"minimum":43.52,"maximum":767.17,"gross_charge":939,"discounted_cash":215.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":83.11,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":497.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":767.17,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":58.27,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":57.71,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":57.99,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN 25% 12.5GM 50ML INJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5216-09","type":"NDC"}],"standard_charges":[{"minimum":249.1,"maximum":383.99,"gross_charge":470,"discounted_cash":107.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":249.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.99,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN 25% 12.5GM 50ML INJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5216-09","type":"NDC"}],"standard_charges":[{"minimum":43.52,"maximum":383.99,"gross_charge":470,"discounted_cash":107.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":80.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":249.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN 25% 25GM 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5216-02","type":"NDC"}],"standard_charges":[{"minimum":810.9,"maximum":1250.01,"gross_charge":1530,"discounted_cash":350.37,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":810.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.01,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN 25% 25GM 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5216-02","type":"NDC"}],"standard_charges":[{"minimum":43.52,"maximum":1250.01,"gross_charge":1530,"discounted_cash":350.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.58,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":80.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":810.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.01,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"}]}]},{"description":"FFP 8-24HR COLLECTION EA UNIT","code_information":[{"code":"P9059","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":211.47,"maximum":325.99,"gross_charge":399,"discounted_cash":91.38,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":211.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":325.99,"methodology":"fee schedule"}]}]},{"description":"FFP 8-24HR COLLECTION EA UNIT","code_information":[{"code":"P9059","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":52.87,"maximum":325.99,"gross_charge":399,"discounted_cash":91.38,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":205.6,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":154.23,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":211.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":325.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.87,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.87,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":75.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":76.53,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":77.29,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":75.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":75.77,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":75.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":77.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":75.77,"methodology":"fee schedule"}]}]},{"description":"CATH FOR SPECIMEN COLLECT","code_information":[{"code":"P9612","type":"HCPCS"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":36.04,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"}]}]},{"description":"CATH FOR SPECIMEN COLLECT","code_information":[{"code":"P9612","type":"HCPCS"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.08,"maximum":55.56,"gross_charge":68,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":21.35,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":21.35,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500MG/10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0403-10","type":"NDC"}],"standard_charges":[{"minimum":67.84,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500MG/10ML INJ","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0403-10","type":"NDC"}],"standard_charges":[{"minimum":3.94,"maximum":104.58,"gross_charge":128,"discounted_cash":29.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.58,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"}]}]},{"description":"SKIN SUBST 431X-561","code_information":[{"code":"Q4100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1057.88,"maximum":1630.74,"gross_charge":1996,"discounted_cash":457.09,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1057.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1630.74,"methodology":"fee schedule"}]}]},{"description":"SKIN SUBST 431X-561","code_information":[{"code":"Q4100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":279.44,"maximum":1630.74,"gross_charge":1996,"discounted_cash":457.09,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":513.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":513.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1057.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1630.74,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.44,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.44,"methodology":"fee schedule"}]}]},{"description":"SKIN SUBST 949X-1234","code_information":[{"code":"Q4100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2012.94,"maximum":3102.97,"gross_charge":3798,"discounted_cash":869.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2012.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3102.97,"methodology":"fee schedule"}]}]},{"description":"SKIN SUBST 949X-1234","code_information":[{"code":"Q4100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":513.41,"maximum":3102.97,"gross_charge":3798,"discounted_cash":869.75,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":513.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":513.41,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":2012.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3102.97,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.72,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.72,"methodology":"fee schedule"}]}]},{"description":"BMWD 4X10IN 5965X-7755","code_information":[{"code":"Q4104","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9089.5,"maximum":14011.55,"gross_charge":17150,"discounted_cash":3927.35,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9089.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14011.55,"methodology":"fee schedule"}]}]},{"description":"BMWD 4X10IN 5965X-7755","code_information":[{"code":"Q4104","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.71,"maximum":14011.55,"gross_charge":17150,"discounted_cash":3927.35,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":9089.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14011.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"}]}]},{"description":"BMWD 4X10IN 7755X-10082","code_information":[{"code":"Q4104","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":17651.12,"maximum":27209.37,"gross_charge":33304,"discounted_cash":7626.62,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17651.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27209.37,"methodology":"fee schedule"}]}]},{"description":"BMWD 4X10IN 7755X-10082","code_information":[{"code":"Q4104","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.71,"maximum":27209.37,"gross_charge":33304,"discounted_cash":7626.62,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":17651.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27209.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"}]}]},{"description":"BMWD 4X5IN 4588X-5965","code_information":[{"code":"Q4104","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10788.68,"maximum":16630.86,"gross_charge":20356,"discounted_cash":4661.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10788.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16630.86,"methodology":"fee schedule"}]}]},{"description":"BMWD 4X5IN 4588X-5965","code_information":[{"code":"Q4104","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.71,"maximum":16630.86,"gross_charge":20356,"discounted_cash":4661.53,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":148.86,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":148.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":10788.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16630.86,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"}]}]},{"description":"ARTHRFLX 4X7CM 3529X-4588","code_information":[{"code":"Q4125","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5377.38,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"}]}]},{"description":"ARTHRFLX 4X7CM 3529X-4588","code_information":[{"code":"Q4125","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":297.37,"maximum":8289.29,"gross_charge":10146,"discounted_cash":2323.44,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.42,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":297.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":297.37,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8289.29,"methodology":"fee schedule"}]}]},{"description":"ALLOPATCH4X8CM 2087X-2714","code_information":[{"code":"Q4128","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3180.53,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"}]}]},{"description":"ALLOPATCH4X8CM 2087X-2714","code_information":[{"code":"Q4128","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":31.35,"maximum":4902.82,"gross_charge":6001,"discounted_cash":1374.23,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.5,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":73.14,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":73.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":53.73,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3180.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4902.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.35,"methodology":"fee schedule"}]}]},{"description":"STRATT 10X16CM 3529X-4588","code_information":[{"code":"Q4130","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7983.92,"maximum":12307.29,"gross_charge":15064,"discounted_cash":3449.66,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7983.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12307.29,"methodology":"fee schedule"}]}]},{"description":"STRATT 10X16CM 3529X-4588","code_information":[{"code":"Q4130","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":81.92,"maximum":12307.29,"gross_charge":15064,"discounted_cash":3449.66,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":7983.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12307.29,"methodology":"fee schedule"}]}]},{"description":"STRATT 16X20CM 7755X-10082","code_information":[{"code":"Q4130","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15967.84,"maximum":24614.58,"gross_charge":30128,"discounted_cash":6899.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15967.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24614.58,"methodology":"fee schedule"}]}]},{"description":"STRATT 16X20CM 7755X-10082","code_information":[{"code":"Q4130","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":81.92,"maximum":24614.58,"gross_charge":30128,"discounted_cash":6899.32,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":81.92,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":81.92,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":15967.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24614.58,"methodology":"fee schedule"}]}]},{"description":"PALINGEN 2ML 2087X-2714","code_information":[{"code":"Q4174","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4664,"maximum":7189.6,"gross_charge":8800,"discounted_cash":2015.2,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4664,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7189.6,"methodology":"fee schedule"}]}]},{"description":"PALINGEN 2ML 2087X-2714","code_information":[{"code":"Q4174","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":870.81,"maximum":7189.6,"gross_charge":8800,"discounted_cash":2015.2,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1160.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":870.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":870.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2222.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2222.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4664,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7189.6,"methodology":"fee schedule"}]}]},{"description":"PALINGEN 2ML 2714X-3529","code_information":[{"code":"Q4174","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4136.12,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"PALINGEN 2ML 2714X-3529","code_information":[{"code":"Q4174","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":870.81,"maximum":6375.87,"gross_charge":7804,"discounted_cash":1787.12,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1160.89,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":870.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":870.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2222.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":2222.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":4136.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6375.87,"methodology":"fee schedule"}]}]},{"description":"EPIFIX 2X4CM 1234X-1605","code_information":[{"code":"Q4186","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3039.55,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"}]}]},{"description":"EPIFIX 2X4CM 1234X-1605","code_information":[{"code":"Q4186","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":263.08,"maximum":4685.5,"gross_charge":5735,"discounted_cash":1313.32,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.05,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":473.37,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":473.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":263.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":263.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":3039.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4685.5,"methodology":"fee schedule"}]}]},{"description":"EPOETIN EPBX ESRD 10K SDVJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0635","type":"RC"},{"code":"00069-1308-10","type":"NDC"}],"standard_charges":[{"minimum":596.78,"maximum":919.95,"gross_charge":1126,"discounted_cash":257.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":596.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":919.95,"methodology":"fee schedule"}]}]},{"description":"EPOETIN EPBX ESRD 10K SDVJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0635","type":"RC"},{"code":"00069-1308-10","type":"NDC"}],"standard_charges":[{"minimum":0.65,"maximum":919.95,"gross_charge":1126,"discounted_cash":257.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":596.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":919.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"EPOETIN EPBX ESRD 4K SDVJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0634","type":"RC"},{"code":"00069-1307-10","type":"NDC"}],"standard_charges":[{"minimum":239.03,"maximum":368.47,"gross_charge":451,"discounted_cash":103.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":239.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":368.47,"methodology":"fee schedule"}]}]},{"description":"EPOETIN EPBX ESRD 4K SDVJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0634","type":"RC"},{"code":"00069-1307-10","type":"NDC"}],"standard_charges":[{"minimum":0.65,"maximum":368.47,"gross_charge":451,"discounted_cash":103.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":239.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":368.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"EPOETIN EPBX NESRD 10K SDVJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00069-1308-10","type":"NDC"}],"standard_charges":[{"minimum":596.78,"maximum":919.95,"gross_charge":1126,"discounted_cash":257.86,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":596.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":919.95,"methodology":"fee schedule"}]}]},{"description":"EPOETIN EPBX NESRD 10K SDVJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00069-1308-10","type":"NDC"}],"standard_charges":[{"minimum":6.42,"maximum":919.95,"gross_charge":1126,"discounted_cash":257.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":596.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":919.95,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"}]}]},{"description":"EPOETIN EPBX NESRD 4K SDVJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00069-1307-10","type":"NDC"}],"standard_charges":[{"minimum":239.03,"maximum":368.47,"gross_charge":451,"discounted_cash":103.28,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":239.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":368.47,"methodology":"fee schedule"}]}]},{"description":"EPOETIN EPBX NESRD 4K SDVJW","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00069-1307-10","type":"NDC"}],"standard_charges":[{"minimum":6.42,"maximum":368.47,"gross_charge":451,"discounted_cash":103.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.44,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":239.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":368.47,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"}]}]},{"description":"PERFLUTREN 6.52MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"Q9957","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"11994-0011-04","type":"NDC"}],"standard_charges":[{"minimum":937.04,"maximum":1444.46,"gross_charge":1768,"discounted_cash":404.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":937.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1444.46,"methodology":"fee schedule"}]}]},{"description":"PERFLUTREN 6.52MG/ML 2ML INJ","drug_information": {"unit": 2,"type": "ML"},"code_information":[{"code":"Q9957","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"11994-0011-04","type":"NDC"}],"standard_charges":[{"minimum":42.65,"maximum":1444.46,"gross_charge":1768,"discounted_cash":404.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":135.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":135.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":72.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":937.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1444.46,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"}]}]},{"description":"PERFLUTREN MICRO 10MG/ML 3MLIV","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"Q9957","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00407-2707-03","type":"NDC"}],"standard_charges":[{"minimum":759.49,"maximum":1170.77,"gross_charge":1433,"discounted_cash":328.16,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":759.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1170.77,"methodology":"fee schedule"}]}]},{"description":"PERFLUTREN MICRO 10MG/ML 3MLIV","drug_information": {"unit": 3,"type": "ML"},"code_information":[{"code":"Q9957","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00407-2707-03","type":"NDC"}],"standard_charges":[{"minimum":42.65,"maximum":1170.77,"gross_charge":1433,"discounted_cash":328.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.3,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":135.24,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":135.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":72.1,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":759.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1170.77,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"}]}]},{"description":"DIATRIZOATE MEG/NA-66 30ML SOL","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"Q9963","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-0445-35","type":"NDC"}],"standard_charges":[{"minimum":119.25,"maximum":183.83,"gross_charge":225,"discounted_cash":51.53,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":119.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.83,"methodology":"fee schedule"}]}]},{"description":"DIATRIZOATE MEG/NA-66 30ML SOL","drug_information": {"unit": 30,"type": "ML"},"code_information":[{"code":"Q9963","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-0445-35","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":183.83,"gross_charge":225,"discounted_cash":51.53,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":119.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.83,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 200MG/ML 10ML INTH","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1411-11","type":"NDC"}],"standard_charges":[{"minimum":332.84,"maximum":513.08,"gross_charge":628,"discounted_cash":143.82,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":332.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":513.08,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 200MG/ML 10ML INTH","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1411-11","type":"NDC"}],"standard_charges":[{"minimum":0.42,"maximum":513.08,"gross_charge":628,"discounted_cash":143.82,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":332.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":513.08,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"}]}]},{"description":"IODIXANOL 320MG/ML 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0383-04","type":"NDC"}],"standard_charges":[{"minimum":579.29,"maximum":892.99,"gross_charge":1093,"discounted_cash":250.3,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":579.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":892.99,"methodology":"fee schedule"}]}]},{"description":"IODIXANOL 320MG/ML 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0383-04","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":892.99,"gross_charge":1093,"discounted_cash":250.3,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":579.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":892.99,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"IOHEXOL 300MG/ML 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00407-1413-63","type":"NDC"}],"standard_charges":[{"minimum":489.72,"maximum":754.91,"gross_charge":924,"discounted_cash":211.6,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":489.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":754.91,"methodology":"fee schedule"}]}]},{"description":"IOHEXOL 300MG/ML 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00407-1413-63","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":754.91,"gross_charge":924,"discounted_cash":211.6,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":489.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":754.91,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 300MG/ML 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1315-35","type":"NDC"}],"standard_charges":[{"minimum":476.47,"maximum":734.49,"gross_charge":899,"discounted_cash":205.88,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":476.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":734.49,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 300MG/ML 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1315-35","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":734.49,"gross_charge":899,"discounted_cash":205.88,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":476.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":734.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 300MG/ML 50ML INJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1315-30","type":"NDC"}],"standard_charges":[{"minimum":243.8,"maximum":375.82,"gross_charge":460,"discounted_cash":105.34,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":243.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":375.82,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 300MG/ML 50ML INJ","drug_information": {"unit": 50,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1315-30","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":375.82,"gross_charge":460,"discounted_cash":105.34,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":243.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":375.82,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 300MG/ML 75ML INJ","drug_information": {"unit": 75,"type": "UN"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1315-47","type":"NDC"}],"standard_charges":[{"minimum":395.38,"maximum":609.49,"gross_charge":746,"discounted_cash":170.84,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":395.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":609.49,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 300MG/ML 75ML INJ","drug_information": {"unit": 75,"type": "UN"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1315-47","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":609.49,"gross_charge":746,"discounted_cash":170.84,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":395.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":609.49,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 370MG/ML 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1316-35","type":"NDC"}],"standard_charges":[{"minimum":528.94,"maximum":815.37,"gross_charge":998,"discounted_cash":228.55,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":528.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":815.37,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 370MG/ML 100ML INJ","drug_information": {"unit": 100,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1316-35","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":815.37,"gross_charge":998,"discounted_cash":228.55,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":528.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":815.37,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 370MG/ML 75ML INJ","drug_information": {"unit": 75,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1316-52","type":"NDC"}],"standard_charges":[{"minimum":397.5,"maximum":612.75,"gross_charge":750,"discounted_cash":171.75,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":397.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":612.75,"methodology":"fee schedule"}]}]},{"description":"IOPAMIDOL 370MG/ML 75ML INJ","drug_information": {"unit": 75,"type": "ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00270-1316-52","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":612.75,"gross_charge":750,"discounted_cash":171.75,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":397.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":612.75,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"METHYL BLUE50MG/10ML SDVINJ JW","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-0374-05","type":"NDC"}],"standard_charges":[{"minimum":1075.37,"maximum":1657.7,"gross_charge":2029,"discounted_cash":464.65,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1075.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1657.7,"methodology":"fee schedule"}]}]},{"description":"METHYL BLUE50MG/10ML SDVINJ JW","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"00517-0374-05","type":"NDC"}],"standard_charges":[{"minimum":4.81,"maximum":1657.7,"gross_charge":2029,"discounted_cash":464.65,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1075.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1657.7,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"}]}]},{"description":"METHYLE BLUE 100MG/10ML INJ JW","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0147-01","type":"NDC"}],"standard_charges":[{"minimum":1126.25,"maximum":1736.13,"gross_charge":2125,"discounted_cash":486.63,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1126.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1736.13,"methodology":"fee schedule"}]}]},{"description":"METHYLE BLUE 100MG/10ML INJ JW","drug_information": {"unit": 10,"type": "ML"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0147-01","type":"NDC"}],"standard_charges":[{"minimum":4.81,"maximum":1736.13,"gross_charge":2125,"discounted_cash":486.63,"setting":"outpatient","payers_information":[{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|PPO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":1126.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1736.13,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"}]}]},{"description":"NEWBORN SCREENING","code_information":[{"code":"S3620","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":392.2,"maximum":604.58,"gross_charge":740,"discounted_cash":169.46,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":392.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":604.58,"methodology":"fee schedule"}]}]},{"description":"NEWBORN SCREENING","code_information":[{"code":"S3620","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":27.41,"maximum":604.58,"gross_charge":740,"discounted_cash":169.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.41,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":158.16,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":118.64,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":118.64,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":392.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":604.58,"methodology":"fee schedule"}]}]},{"description":"RL-COVID-19 U0001","code_information":[{"code":"U0001","type":"HCPCS"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":19.04,"maximum":29.34,"gross_charge":35.91,"discounted_cash":8.23,"setting":"inpatient","payers_information":[{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.34,"methodology":"fee schedule"}]}]},{"description":"RL-COVID-19 U0001","code_information":[{"code":"U0001","type":"HCPCS"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":19.04,"maximum":257.08,"gross_charge":35.91,"discounted_cash":8.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":257.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.77,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|MaricopaFocus","standard_charge_dollar":56.08,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Commercial|Neighborhood","standard_charge_dollar":56.08,"methodology":"fee schedule"},{"payer_name":"Coventry","plan_name":"Commercial|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Navigate","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"Medicare|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"BCBS - AZ","plan_name":"Medicare|All Plans","standard_charge_dollar":36.27,"methodology":"fee schedule"},{"payer_name":"Devoted HP","plan_name":"Medicare|All Plans","standard_charge_dollar":36.99,"methodology":"fee schedule"},{"payer_name":"Fresenius","plan_name":"Medicare|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Health Choice","plan_name":"Medicare|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"Mercy Care","plan_name":"Medicare|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Medicare|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"Medicare|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"}]}]}],"modifier_information": [{"description": "Item designated by FDA as Class III Devices", "code": "KF", "modifier_payer_information": [{"payer_name": "Fresenius","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Health Choice","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - AZ","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Devoted HP","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "United","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "WellCare","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Mercy Care","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Replacement of facial prosthesis including new impression/moulage", "code": "KM", "modifier_payer_information": [{"payer_name": "Humana","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Health Choice","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Mercy Care","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "WellCare","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "United","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - AZ","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Fresenius","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Devoted HP","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Replacement of facial prosthesis", "code": "KN", "modifier_payer_information": [{"payer_name": "Devoted HP","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Fresenius","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - AZ","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "United","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "WellCare","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Mercy Care","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Health Choice","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"}]}],"general_contract_provisions": [ 
{ "payer_name": "Aetna", "plan_name": "Commercial|All Other Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Aetna", "plan_name": "Commercial|PPO", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "BCBS - AZ", "plan_name": "Commercial|All Other Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "BCBS - AZ", "plan_name": "Commercial|MaricopaFocus", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "BCBS - AZ", "plan_name": "Commercial|Neighborhood", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Cigna", "plan_name": "Commercial|All Other Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 97 Percent of Billed Charges" },{ "payer_name": "Cigna", "plan_name": "Commercial|PPO", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 97 Percent of Billed Charges" },{ "payer_name": "United", "plan_name": "Commercial|All Other Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "United", "plan_name": "Commercial|Navigate", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "United", "plan_name": "Commercial|Options", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "United", "plan_name": "Medicaid|All Plans", "description": "Outpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "United", "plan_name": "Medicare|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" }]}